Annabel, I don't think Blue Cross gets to "send your Mother" anywhere. She needs specialized treatment and if there are no specialists [ie-people who do this ALL the time]in network, then she should have any out of network costs covered. Do you have an active State Insurance Commission? If so, talk to them. Amy

Yeah we have an active insurance commissioner that's why our auto insurance rates are going through the roof. I couldn't find anything from the State of Kalifornia about any regulation of medical insurance, omsbudman or anything.

But you can't own a pellet gun in San Francisco. We have a lot of political grandstanders here who don't do sh*t about the real issues. I was born and raised here and I am beginning to hate it here. Our school system here sucks in spite of annual begging for more money. If it wasn't for Mississippi we would ranked #50. Sorry, I'm just having a pity party and venting tonight.

Dear Gary, come see us in Cherokee village [alot of Kalif. folks are moving here] We are really back woods here, but our Ins. Commission took on John Alden Ins. for me and we got paid. Our schools are good and the 1st day of deer season is a holiday, in case you are interested. If not, you can just go play golf or fish that day Amy

I just shoot targets and people -I don't like harming furry little animals. Golf sounds good however. One of my best friends lives in Arkansas. Plays in a band there. We had a band going Kalifornia for a while. I'll email a link as soon as I find it - they're supposed to be pretty popular there.

I have Blue Cross/Blue Shield Federal and my policy has a specific line that states "restore the mouth to a pre-cancerous state". They did cover both an Iliac crest (hip) implant to my upper jaw and dental implants.

On my initial surgery, an oral surgeon had to pull three teeth prior to the ENT removing my tumor (same surgery room/same day/same time), but blue cross initially denied the dental portion of the claim. I called them and explained that the removal of teeth was an integral part of the cancer surgery and they covered the expenses.

Hopefully your policy reads the same, otherwise shame on them.

My husband will have to get teeth implants because of cancer of the mandible (it was replaced) 3 years ago. Would you believe the insurance co (Anthem blue cross blue shield ) had okayed it last year, but he had to have one more surgery to remove scar tissue from under his tongue this January and now the insurance company is refusing to pay.
I remember years ago, maybe 30 yrs, my friend had to have a double masectamay and her insurance refused it, but they fought the insurance co and they paid for implants. Now what is the difference? I know its a psychological thing more than a needed replacement. My husband's side of his face is caving in a little and it's very difficult for him to eat. People can see that but they can't see someone's breast implants (at least I hope not) lol. I hope I make sense.

I am writing with questions about insurance coverage for dentures after oral cancer, chemo and radiation treatment. I have had dentures for nearly 50 years previous to oral cancer. After treatment, because of adhesions in my mouth, my dentures no longer fit and I had to have new ones made. I have contacted Medicare and they have denied my claim. I sent them letters from my ENT, Oncologist, and Radiation Oncologist, all stating the importance of teeth (in my case dentures) in maintaining good health; for without teeth, one cannot get adequate nutrition to maintain good health. My claim continues to be denied. I also sent letters to Senators in Minnesota requesting that perhaps they could introduce a bill requiring medicare to pay for teeth after oral cancer treatment when it is medically necessary. After all, medicare will pay for a wig, arm or leg prostheses in follow-up to cancer, why not teeth, which are a prosthesis as well. Anyway, does anyone have any suggestions on how to continue in the pursuit of my claim to medicare? Will welcome your input.

1-1/2 year post squamous cell cancer tongue with removal of 2/3 of the right side of my tongue, and neck dissection to the right side of my neck, followed by chemo and radiation.

Kate....Do you have BC/BS? Maybe you should go to the BC/BS headquarters right there in Eagan and ask to talk to a manager in the claims area. Be firm and emphasize the valid points you just mentioned in your forum message. Good luck! JaneP
(we used to live in Eagan, so we know the area)

I never had any luck convincing Cigna or Aetna, don't remember which one I had at the time, to pay for my dentures despite letters from doctors. They were perfectly willing to pay for surgical, rather than dental, removal of the teeth but not one cent for replacement teeth. Said I had to file under dental coverage which has a max of $1800 a year. Teeth are not a medical necessity according to them.

Your points are all valid. Good luck with medicare. See if you can find anything in the writing that says they won't cover this or they only cover it if ...

I find dread the day when I have to go under Medicare having fought some battles with them for my parents.

Good luck and keep fighting.
Eileen

I fought many battles with Anthem Blue Cross/Blue Shield to no avail. They will NOT cover implants nor dentures. Good luck with it.