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#110953 - 01/25/10 08:59 PM Fluoride Trays and Insurance  
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ESikon Offline
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ESikon  Offline
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Texas
I'm having a hard time getting my dental carriers that I already purchased out of pocket reimbursed. I submitted to medical and they denied saying it was a dental issue, so I sent it to Dental and they denied saying ask medical. I have a letter from the dentist indicating the importance of the device, you would think dental would cover it to prevent them from having to spend more money in the future on my dental bills!!!!

Did anyone have any luck with getting insurance to cover the trays? Was it medical or dental? Any advice would be great!




Dx 3/27/09 @ 28 years old with High Grade MEC T4N2M0
Elizabeth, 33, mother of 3 girls (4,7, &8yrs old)
3 rds of chemo(Carbo/Taxol)
Rt Mandibulectomy, rt fibular flap,& rt ND with trach, picc,& g-tube.
30 rds of rads with weekly cisplatin
SCANS ALL CLEAR!
OCF Regional Coordinator of San Antonio Walk
#110959 - 01/25/10 10:06 PM Re: Fluoride Trays and Insurance [Re: ESikon]  
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Carmen M Offline
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Carmen M  Offline
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Idaho
No. I went through the same circle you are going through. Ultimately they were denied by Dental because items like that were specifically excluded from my dental plan and they were denied by my medical because they are a dental apparatus. Basically, I gave up.


DX 2/10/09; Stage 1 SCC side of tongue; Partial Gloss; PEG in 3/3/09; 3 Cisplatin; 35 IMRT; PEG out 7/17/09; Eating via mouth and walking 3 miles/day 4 wks after treatment end. 50 pound weight loss; Clear PET 09/09 and 09/10
#110960 - 01/25/10 10:17 PM Re: Fluoride Trays and Insurance [Re: Carmen M]  
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Charm2017 Offline
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Charm2017  Offline
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Alexandria VA
I don't have dental insurance so the medical insurance would not cover the fluoride trays even though they were medically necessary. My insurance did cover the prescription flouride gel though to put into the trays.
Charm


65 yr Old Frack
Stage IV BOT T3N2M0 HPV 16+
2007:72GY IMRT(40) 8 ERBITUX No PEG
2008:CANCER BACK Salvage Surgery
25GY-CyberKnife(5) 3 Carboplatin
Apaghia /G button
2012: CANCER BACK -left tonsilar fossa
40GY-CyberKnife(5) 3 Carboplatin

Passed away 4-29-13
#111102 - 01/28/10 02:22 AM Re: Fluoride Trays and Insurance [Re: Charm2017]  
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DonB Offline
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DonB  Offline
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San Diego, California
My trays were covered under my medical insurance.

They also covered the dental exams and panoramic dental x ray.

My Cancer Center is part a of a very large Medical complex that has a Dental group of Maxillofacial Prosthodontistsis and all OC patient have to go through that Dental group for pre Tx evaluation, tray fitting, interim and post Tx follow ups, so that might have made a difference from the insurance billing perspective.

Also, (FYI) I didn't need any dental work done.




Don
TXN2bM0 Stage IVa SCC-Occult Primary
FNA 6/6/08-SCC in node<2cm
PET/CT 6/19/08-SCC in 2nd node<1cm
HiRes CT 6/21/08
Exploratory,Tonsillectomy(benign),Right SND 6/23/08
PEG 7/3/08-11/6/08
35 TomoTherapy 7/16/08-9/04/08 No Chemo
Clear PET/CT 11/15/08, 5/15/09, 5/28/10, 7/8/11

#111111 - 01/28/10 05:22 AM Re: Fluoride Trays and Insurance [Re: DonB]  
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ESikon Offline
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ESikon  Offline
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Texas
Thanks everyone!

Don--I went to MD Anderson and also saw their dental people (no dental work needed either), I may try one more time to go through medical but I've pretty much think it will be a no go.



Dx 3/27/09 @ 28 years old with High Grade MEC T4N2M0
Elizabeth, 33, mother of 3 girls (4,7, &8yrs old)
3 rds of chemo(Carbo/Taxol)
Rt Mandibulectomy, rt fibular flap,& rt ND with trach, picc,& g-tube.
30 rds of rads with weekly cisplatin
SCANS ALL CLEAR!
OCF Regional Coordinator of San Antonio Walk
#111133 - 01/28/10 04:04 PM Re: Fluoride Trays and Insurance [Re: ESikon]  
Joined: Jul 2008
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DonB Offline
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DonB  Offline
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San Diego, California
Just curious; what is the cost of a set a trays?



Don
TXN2bM0 Stage IVa SCC-Occult Primary
FNA 6/6/08-SCC in node<2cm
PET/CT 6/19/08-SCC in 2nd node<1cm
HiRes CT 6/21/08
Exploratory,Tonsillectomy(benign),Right SND 6/23/08
PEG 7/3/08-11/6/08
35 TomoTherapy 7/16/08-9/04/08 No Chemo
Clear PET/CT 11/15/08, 5/15/09, 5/28/10, 7/8/11

#111142 - 01/28/10 06:33 PM Re: Fluoride Trays and Insurance [Re: DonB]  
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Eileen Offline
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Trenton, New Jersey
Mine were $400 in 1997 and no amount of arguing about medical necessity would convince either the medical or dental to cover them. My dental also will not cover fluoride treatments for anyone over 18. Good luck fighting this.

Take care,
Eileen


----------------------
Aug 1997 unknown primary, Stage III
mets to 1 lymph node in neck; rt ND, 36 XRT rad
Aug 2001 tiny tumor on larynx, Stage I total laryngectomy; left ND
June 5, 2010 dx early stage breast cancer
June 9, 2011 SCC 1.5 cm hypo pharynx, 70% P-16 positive, no mets, Stage I
#111144 - 01/28/10 06:42 PM Re: Fluoride Trays and Insurance [Re: Eileen]  
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ESikon Offline
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ESikon  Offline
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Texas
I hear ya Eileen, I guess its worth a try but I dont have high expectations.

Don- My trays cost $306.00.


Dx 3/27/09 @ 28 years old with High Grade MEC T4N2M0
Elizabeth, 33, mother of 3 girls (4,7, &8yrs old)
3 rds of chemo(Carbo/Taxol)
Rt Mandibulectomy, rt fibular flap,& rt ND with trach, picc,& g-tube.
30 rds of rads with weekly cisplatin
SCANS ALL CLEAR!
OCF Regional Coordinator of San Antonio Walk
#111202 - 01/29/10 02:49 PM Re: Fluoride Trays and Insurance [Re: ESikon]  
Joined: Jan 2010
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Nurse Ratched Offline
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Nurse Ratched  Offline
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St. Louis, Mo USA
We just picked up Mike's set of dental trays - cost: $230.00. That sounds pretty cheap compared to the responses above. I'm going to try claiming it against medical insurance as Mike hit the max for dental already for the year and it wouldn't cover it anyway but am not holding out much hope! All I could find in our medical plan was that they cover "limited" adjunctive care for dental but no specifics. If they don't cover it, I am hoping maybe they will apply it to our "catastrophic cap" total for the year.


Caregiver/wife to Mike, age 48 used chewing tobacco - quit
SCC BOT T2N3M0 Diagnosed Dec 29, 09 HPV+
L ND Jan 7 removed 31 nodes, 6 positive Bilat mets neck
Siteman Cancer Center
Port in Jan 27, Peg in Mar 3
IC 28 Jan & 18 Feb - TPF
CRT Cisplatin x3 start March 10th
#111336 - 02/01/10 12:05 AM Re: Fluoride Trays and Insurance [Re: Nurse Ratched]  
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Posts: 104
mgmichael Offline
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northern California
John had/has no dental coverage and we spent a bundle on dental care needed prior to starting radiation--the dentist had the trays made gratis! I had no idea that the flimsy little things cost as much as what I'm seeing on here. Yikes! A lot less than the crowns and stuff, though.


GM, for John who has SCC Rt tonsil with 3+ nodes, Stage T1 N2b MX; surgery 04/09; Rad X 33 completed 7/14/09...f/u imaging and scopes looking good as of Feb 2011
#111818 - 02/06/10 06:05 PM Re: Fluoride Trays and Insurance [Re: mgmichael]  
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Posts: 3,552
Gary Offline
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Gary  Offline
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San Francisco CA
Dental trays are primarily used for cosmetic purposes, such as teeth whitening so I haven't heard, yet, of any insurance co., dental or medical paying for them. Unfair - yes, but much of life is. Like John above my dentist made them for me gratis. Small reward for not referring me sooner to an ENT after my repeated requests of "What the hell is this large tan rubbery blob in my throat, pushing my uvula to the side?"...

They were 200 bucks (if I had to pay for them) at the time and they had to do a full mouth impression. They should be stored on the full mouth impression mold(s) to keep their shape. I still use mine 7 years post Tx. Your gums are going to take a beating from the radiation you will need them.

Look on the bright side - at least he has his teeth. Trays are very cheap insurance. You can write them off.


Gary Allsebrook
***********************************
Dx 11/22/02, SCC, 6 x 3 cm Polypoid tumor, rt tonsil, Stage III/IVA, T3N0M0 G1/2
Tx 1/28/03 - 3/19/03, Cisplatin ct x2, IMRT, bilateral, with boost, x35(69.96Gy)
________________________________________________________
"You are a mist that appears for a little while and then vanishes" (James 4:14 NIV)
#112107 - 02/10/10 02:15 PM Re: Fluoride Trays and Insurance [Re: Gary]  
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homershoney Offline
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homershoney  Offline
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spring, texas (houston)
andys were $300. $150 down, and $150 when they came in. ins didnt cover them. good luck.


Teresa
-----------
CG to ANDY. Nasopharyngeal Carcinoma (NPC)
T2N2cMxG4 stage 4. 43 @ dx 8/31/09
tx 9/21/09-11/06/09 cispatin/docetaxel/5-FU X3
PORT 9/9/09, PEG 12/07/09
35 IMRT-1/wk carbo 11/30/09-2/3/10
tx stopped due to complications
IMRT BOOST 3/08-3/12/10
PET 4/12/10 CLEAR!
PEG out 4/14/10
#117737 - 06/10/10 06:21 PM Re: Fluoride Trays and Insurance [Re: mgmichael]  
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Pat_451 Offline
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Pat_451  Offline
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Iowa
When my husband received his trays they were not covered on my medical or dental insurance. That was a cost that we had to pay out of pocket


Crgvr to Husband 55-yrs, surgery to remove cyst-diagnosed as SCC, 4/3/09 CT & Pet Scan showed more cancer in left lymph node and primary at the base of the tongue.TX Radiation 7 weeks 5 days a week last day is 6/25/09
Chemo completed 6/19/09
Peg Tube 5/22/09
#133275 - 04/22/11 06:04 PM Re: Fluoride Trays and Insurance [Re: mgmichael]  
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chrisclu Offline
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CA
Mine was covered by medical insurance (as it should be) as Cancer is a medical condition. Appeal the decision by the medical insurance company and copy the insurance commissioner of your state.


Stage 4 squamous cell tonsil cancer. Two lymph nodes involved surgically removed before source found to be tonsil. Implant radiation right on tonsil, regular mask radiation therapy for two months and a final Implant radiation. All clear confirmed by PET scans for 6 years.
#133280 - 04/22/11 10:06 PM Re: Fluoride Trays and Insurance [Re: chrisclu]  
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ChristineB Offline
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ChristineB  Offline
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PA
Chris, this is an old post, I doubt Elizabeth is able to go back 15 months to make an appeal. Please watch the dates when responding to posts and giving advice.

Ex.... I just had to move a post to put it where it was more relevant. The original post was a few years old. Sadly 3 of the members who commented on the thread have passed away. So please watch the dates, as not to upset any family members by giving advice to someone who is no longer with us. It hurts reading the words of my deceased friends!


Christine
SCC 6/15/07 L chk & by L molar both Stag I, age44
2x cispltn-35 IMRT end 9/27/07
-65 lbs in 2 mo, no caregvr
Clear PET 1/08
4/4/08 recur L chk Stag I
surg 4/16/08 clr marg
215 HBO dives
3/09 teeth out, trismus
7/2/09 recur, Stg IV
8/24/09 trach, ND, mandiblctmy
3wks medicly inducd coma
2 mo xtended hospital stay, ICU & burn unit
PICC line IV antibx 8 mo
10/4/10, 2/14/11 reconst surg
OC 3x in 3 years
very happy to be alive smile
#133285 - 04/22/11 11:50 PM Re: Fluoride Trays and Insurance [Re: ChristineB]  
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Charm2017 Offline
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Charm2017  Offline
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Alexandria VA
Whatever happened to Brian's' plan to lock down down old posts . It's not only annoying but distressing when they resurrecting a three year old post from dead members we knew like another poster just did with Pete D. ( I complained about that one too) But since this post is still here, let me disagree

Gary is right here that most insurance companies will not and do not pay for flouride trays. If you read your contract, dental expenses like this are usually excluded from health benefit coverage even if they are now required as a consequence of having cancer.
Perhaps you might have some luck in California where the state is very active (gift cards that expire in the other 49 states don't expire there) in regulation but I know that the fluoride trays are not reimbursed under the Blue Cross/Blue Shield insurance plans.

Last edited by Charm2017; 04/23/11 12:02 AM. Reason: toned it down

65 yr Old Frack
Stage IV BOT T3N2M0 HPV 16+
2007:72GY IMRT(40) 8 ERBITUX No PEG
2008:CANCER BACK Salvage Surgery
25GY-CyberKnife(5) 3 Carboplatin
Apaghia /G button
2012: CANCER BACK -left tonsilar fossa
40GY-CyberKnife(5) 3 Carboplatin

Passed away 4-29-13
#133602 - 04/29/11 08:14 PM Re: Fluoride Trays and Insurance [Re: ChristineB]  
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Posts: 20
chrisclu Offline
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chrisclu  Offline
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CA
Originally Posted By: ChristineB
Chris, this is an old post, I doubt Elizabeth is able to go back 15 months to make an appeal. Please watch the dates when responding to posts and giving advice.

Ex.... I just had to move a post to put it where it was more relevant. The original post was a few years old. Sadly 3 of the members who commented on the thread have passed away. So please watch the dates, as not to upset any family members by giving advice to someone who is no longer with us. It hurts reading the words of my deceased friends!


Sorry. I didn't even notice the date. I'm still fairly new here.
Have a good weekend,
Chris


Stage 4 squamous cell tonsil cancer. Two lymph nodes involved surgically removed before source found to be tonsil. Implant radiation right on tonsil, regular mask radiation therapy for two months and a final Implant radiation. All clear confirmed by PET scans for 6 years.
#134083 - 05/10/11 07:28 PM Re: Fluoride Trays and Insurance [Re: chrisclu]  
Joined: May 2011
Posts: 1
sameh El-Ebrashi Offline
Member
sameh El-Ebrashi  Offline
Member

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Posts: 1
portland, Oregon
I think Fluoride trays are critical for many folks who are having RT, and they can be the difference between saving teeth vs not, since Radiation caries can be rampant.
I agree with trying to have medical insurance pay for them, since they are primarily for dealing with effects of Tx from RT

#134087 - 05/10/11 11:13 PM Re: Fluoride Trays and Insurance [Re: sameh El-Ebrashi]  
Joined: Mar 2008
Posts: 3,082
Charm2017 Offline
Patient Advocate (old timer, 2000 posts)
Charm2017  Offline
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Alexandria VA
Sameh

Welcome to OCF. Well said. Your profile says you are a dentist. Has it been your experience that your patients can get reimbursed by their insurance? My impression was that most posters had difficulty or total refusal by their insurance company to pay for the trays. It was so strange to have my insurance deny payment claiming I don't have the optional federal dental insurance, but still pay every month for the prescription flouride gel.
No body disagrees with trying, but the question is whether the effort is futile or fruitful. As a dentist you would be a good position to share with us your experiences with whether insurance pays for the flouride trays you make for your patients.
Charm



65 yr Old Frack
Stage IV BOT T3N2M0 HPV 16+
2007:72GY IMRT(40) 8 ERBITUX No PEG
2008:CANCER BACK Salvage Surgery
25GY-CyberKnife(5) 3 Carboplatin
Apaghia /G button
2012: CANCER BACK -left tonsilar fossa
40GY-CyberKnife(5) 3 Carboplatin

Passed away 4-29-13
#134323 - 05/19/11 02:36 PM Re: Fluoride Trays and Insurance [Re: Charm2017]  
Joined: Jun 2009
Posts: 440
ESikon Offline
Platinum Member (300+ posts)
ESikon  Offline
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Texas
WOW! So much time has past since this post and I never got reimbursed!!LOL I tried and tried but gave up. In my case the effort was futile but if you don't ask and try you will never know.


Dx 3/27/09 @ 28 years old with High Grade MEC T4N2M0
Elizabeth, 33, mother of 3 girls (4,7, &8yrs old)
3 rds of chemo(Carbo/Taxol)
Rt Mandibulectomy, rt fibular flap,& rt ND with trach, picc,& g-tube.
30 rds of rads with weekly cisplatin
SCANS ALL CLEAR!
OCF Regional Coordinator of San Antonio Walk
#134326 - 05/19/11 02:41 PM Re: Fluoride Trays and Insurance [Re: ESikon]  
Joined: Mar 2008
Posts: 3,082
Charm2017 Offline
Patient Advocate (old timer, 2000 posts)
Charm2017  Offline
Patient Advocate (old timer, 2000 posts)

Joined: Mar 2008
Posts: 3,082
Alexandria VA
Elisabeth

You are so right that you have to at least try. I know I feel better having appealed my insurance denial up thru two levels at OPM. It turned out just like Gary posted. Still it sucks and is patently unfair to us oral cancer patients.
Charm


65 yr Old Frack
Stage IV BOT T3N2M0 HPV 16+
2007:72GY IMRT(40) 8 ERBITUX No PEG
2008:CANCER BACK Salvage Surgery
25GY-CyberKnife(5) 3 Carboplatin
Apaghia /G button
2012: CANCER BACK -left tonsilar fossa
40GY-CyberKnife(5) 3 Carboplatin

Passed away 4-29-13
#134868 - 06/05/11 05:00 AM Re: Fluoride Trays and Insurance [Re: Charm2017]  
Joined: May 2010
Posts: 638
klo Offline
"OCF Down Under"
klo  Offline
"OCF Down Under"
"Above & Beyond" Member (500+ posts)

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Sydney Australia
Question: Is the water fluoridated in the US? No one has said a word about fluoride trays to Alex and I here and I figured it would be a battle I could have with Alex in the future as he will not countenence any more "treatment" right now. It occurs to me that the reason no one has suggested it is because our water has fluoride added and maybe the US water doesn't???
Karen


Karen
Love of Life to Alex T4N2M0 SCC Tonsil, BOT, R lymph nodes
Dx March 2010 51yrs. Unresectable. HPV+ve
Tx Chemo x 3+1 cycles(cisplatin,docetaxel,5FU)- complete May 31
Chemoradiation (IMRTx35 + weekly cisplatin)
Finish Aug 27
Return to work 2 years on
3 years out Aug 27 2013 NED smile
Still underweight
#134879 - 06/05/11 02:11 PM Re: Fluoride Trays and Insurance [Re: klo]  
Joined: Jun 2007
Posts: 9,715
ChristineB Offline
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ChristineB  Offline
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PA

Per Wikipedia.....A 1992 census found that, for U.S. public water supply systems reporting the type of compound used, 63% of the population received water fluoridated with fluorosilicic acid, 28% with sodium fluorosilicate, and 9% with sodium fluoride.

I know the above figures are not correct since it does not account for houses that use wells. The house I used to live in had well water as did everyone else within a 10 mile radius. When I attempt to find out how many households depend on wells I get several different figures, up to 10% of the population.


Christine
SCC 6/15/07 L chk & by L molar both Stag I, age44
2x cispltn-35 IMRT end 9/27/07
-65 lbs in 2 mo, no caregvr
Clear PET 1/08
4/4/08 recur L chk Stag I
surg 4/16/08 clr marg
215 HBO dives
3/09 teeth out, trismus
7/2/09 recur, Stg IV
8/24/09 trach, ND, mandiblctmy
3wks medicly inducd coma
2 mo xtended hospital stay, ICU & burn unit
PICC line IV antibx 8 mo
10/4/10, 2/14/11 reconst surg
OC 3x in 3 years
very happy to be alive smile
#134883 - 06/05/11 04:39 PM Re: Fluoride Trays and Insurance [Re: ChristineB]  
Joined: Dec 2010
Posts: 5,260
Cheryld Offline
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Posts: 5,260
Toronto canada
We haver lurked in our water here in Canada and I was still told to get flouride trays - I would ask - it's important - your don't want to have to have a tooth pulled post radiation if you can avoid it.


Cheryl : Irritation - 2004 BX: 6/2008 : Inflam. BX: 12/10, DX: 12/10 : SCC - LS tongue well dif. T2N1M0. 2/11 hemigloss + recon. : PND - 40 nodes - 39 clear. 3/11 - 5/11 IMRT 33 + cis x2, PEG 3/28/11 - 5/19/11 3 head, 2 chest scans - clear(fingers crossed) HPV-, No smoke, drink, or drugs, Vegan
#134911 - 06/06/11 11:52 AM Re: Fluoride Trays and Insurance [Re: Cheryld]  
Joined: May 2009
Posts: 127
mightymouse Offline
Senior Member (100+ posts)
mightymouse  Offline
Senior Member (100+ posts)

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Posts: 127
Connecticut
The fluoridated water isn't enough to really protect your teeth. My surgeon and prosthodontist said the fluoride trays were a must, and for the rest of my life (it's not that big a deal to do daily). This all to prevent tooth decay and, as Cheryl says, to prevent your ever needing to have a tooth pulled post radiation.


Chris

Stage 2 SCC upper right palate
Hemi-palatectomy and maxillectomy 5/28/09
Six teeth gone
IMRT x30 starts July 13. Completed 8/26/09
Carboplatin and Taxol x6 starting 7/14/09. Completed 8/25/09.
#134926 - 06/06/11 06:42 PM Re: Fluoride Trays and Insurance [Re: mightymouse]  
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Posts: 3,082
Charm2017 Offline
Patient Advocate (old timer, 2000 posts)
Charm2017  Offline
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Alexandria VA
Karen

We definitely have lots of flouride in our Washington DC area water (along with an array of other chemicals) but my prosthodontist said the same thing: it's not enough flouride and not concentrated on the teeth and that flouride trays are the way to go.
If you do go that way, I recommend being sure to get a "gel" with a narrow nozzle and not a toothpaste type flouride - there was an interesting discussion here a while ago about using a syringe to make the toothpaste cream type work, but I find it easier to just buy the type that works right out of the little tube it come in.
Last but not least, while my insurance refused to pay for the flouride trays, they continue to pay for two full tubes of the prescription flouride each and every month with no quibble.
Charm


65 yr Old Frack
Stage IV BOT T3N2M0 HPV 16+
2007:72GY IMRT(40) 8 ERBITUX No PEG
2008:CANCER BACK Salvage Surgery
25GY-CyberKnife(5) 3 Carboplatin
Apaghia /G button
2012: CANCER BACK -left tonsilar fossa
40GY-CyberKnife(5) 3 Carboplatin

Passed away 4-29-13
#140737 - 09/29/11 12:31 AM Re: Fluoride Trays and Insurance [Re: Charm2017]  
Joined: Aug 2011
Posts: 4
DonnaD Offline
Member
DonnaD  Offline
Member

Joined: Aug 2011
Posts: 4
IL, USA
Sometimes the problem with getting these things covered has to do with the coding. Make sure the coding done in the dentist office is correct for cancer and not cosmetic. Don't know if it helps. We just had dental deny, turfing it to medical. I'm going to confirm coding with our dentist and then I'm going to medical next. On one hand, I can't complain as our insurance has covered almost everything. On the other hand - I pay dearly for 2 insurance policies and it is a necessity for head and neck radiation.
Donna - RN, BSN, COS-C


Hubby age 65 -dx 6/11 SCC T4aN2bMX-floor of mouth
8/11 surgery- radical neck dissection, partial mandibulectomy, flap reconstruction
plan: radiation (300 rads x5d/w x 6), chemo (5FU, Taxol, Hydroxyurea) x 6
3/13 bilateral lung mets confirmed on biopsy - radiation
5/13 - no new lesions seen on CT, some size decrease in old lesions; 6 mm mediastinal node
9/13 New 12mm x 9 mm RLL lesion - radiation
1/14 - Prominent mediastinal lymph nodeS
1-2 PPDx40y smoker - SEVERE emphysema
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