#53254 05-23-2007 08:16 AM | Joined: Apr 2005 Posts: 50 Supporting Member (50+ posts) | OP  Supporting Member (50+ posts)
Joined: Apr 2005 Posts: 50 | I have read other stories on others battling the insurance company to pay for implants. My husband is having 3 implants placed in his lower jaw as to have a removeable lower device that is more stable so he can eat. He tried two sets of dentures to no avail, so this is what we are trying now. I am fighting Blue Cross as they say they will only cover work done from an accident, but not cancer. This is grossly unfair. This should be treated as cancer is anywhere else in one's body. If a prosthetic leg would be needed, it would be covered. I am so upset...does anyone know who I could take this to in the state of Michigan as this should not happen to anyone. Any information would be greatly appreciated.
Virginia
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#53255 05-23-2007 03:51 PM | Joined: Jul 2003 Posts: 235 Gold Member (200+ posts) | | Gold Member (200+ posts)
Joined: Jul 2003 Posts: 235 | Hi Virginia,
Each state has an insurance regulatory board, you may want to try that route. I don't know how heavily influenced they are by lobbyists, but it's worth a shot. I'd also ask the hospital social worker if they have any ideas about how to approach this issue with BCBS. I wouldn't stop there either. I'd also consider getting help from the local press. I've read and heard of stories where people have gotten help from their local television news or local newspaper. Sometimes this catches the interest of a reporter or consumer activist and they report on it or will call the insurance company and inquire as to why a particular procedure or prosthetic isn't covered. To save face, and eliminate the potential of getting bad press, some companies end up paying the claim. Best of luck.
Dave
Mom's caregvr. DDS failed to dx 01/03. Dx Stg IV SCC 05/03. Induct. chemo, IMRT, 5FU, H, Iressa, Neck disect, radiation. Dad's caregvr. Dx 01/04 Ext. Stg SCLC. Mets to liver/bone 08/04. Died 11/12/04. Mom tongue CA dx 06/13, hemiglossectomy (80% removed) 08/13. Clean margins and nodes, but PNI. 6/15/15: Tongue CA at base of remnant tongue. Declined further tx; hospice.
Died 10/13/15. What a long and difficult journey.
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#53256 05-23-2007 04:01 PM | Joined: Aug 2003 Posts: 1,627 Patient Advocate (1000+ posts) | | Patient Advocate (1000+ posts)
Joined: Aug 2003 Posts: 1,627 | Virginia,
I battled with BC/BS to no avail. They were firm with their policy that it had to be necessary because of an accident rather then from a disease process. I had my doctors, the Ombudsman here local.........nothing, just a flat NOPE, we don't cover it. Now, if I had gone to a bar, gotten drunk, gotten in my car and wrapped that car around a tree, damaging my teeth.........it would be covered. Go figure.
Let me know if you get anywhere,
Minnie
SCC Left Mandible. Jaw replaced with bone from leg. Neck disection, 37 radiation treatments. Recurrence 8-28-07, stage 2, tongue. One third of tongue removed 10-4-07. 5-23-08 chemo started for tumor behind swallowing passage, Our good friend and much loved OCF member Minnie has been lost to the disease (RIP 10-29-08). We will all miss her greatly.
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#53257 05-24-2007 11:06 PM | Joined: Apr 2005 Posts: 50 Supporting Member (50+ posts) | | OP Supporting Member (50+ posts)
Joined: Apr 2005 Posts: 50 | Thank you for all your advice. I emailed my local news station that sometimes does exposes on such things, and I'm going to be a real pain and keep complaining whether or not they pay. This is a gross negligence of the system. If someone needed a prosthetic device anywhere else in the body due to cancer other than the mouth it would be covered..something needs to be done, and I'm going to keep complaining until more light is shed on this. Thanks again, Virginia
Virginia
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