thanks for everyone's input.
the letter below follows the insurance company's guidelines.

we'll see how it goes.

cu,
larryb


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Dear Customer Care Representative,

I have been a BCBS participant for more than 10 years. This letter is in response to the BCBS denial of payments for 1.1% Sodium Fluoride dental cream. BCBS has paid for this medication for 7 years, so this denial was a surprise to me and seems to be due to a misunderstanding. My medical condition has not changed and will persist. Herein I review the circumstances so that the error can be corrected.

In 2001, I was treated with radiation and chemotherapy for oral cancer. Radiation treatment for the illness resulted in me having Xerostomia. The attached material explains Xerostomia and states 'To protect against tooth decay during and after treatments, patients with xerostomia should apply fluoride to the teeth daily to protect them.' I have followed that protocol since 2001 and continue to do so. Until now, BCBS has paid the co-pay. The facts:
a) I have a medical condition, Xerostomia.
b) My physician, Dr. S a licensed dentist in the US, prescribed fluoride treatment.
c) The drug is FDA regulated and only available by prescription.
d) The treatment is normal\standard\recommended for the condition that I have.
e) I purchased a generic equivalent.
f) I purchased the medication at a retail pharmacy.
This medication is for treatment of an Existing Medical Condition. Therefore the appropriate section of 2008 BCBS Service Benefit Plan book is Pages 85-87, where the requirements for payment of Covered Medications are presented. The facts of my claim conform to those requirements for BCBS payment of 'Drugs, vitamins and minerals, and nutritional supplements that by Federal law of the United States require a prescription for their purchase.' On the other hand, the BCBS handbook does not list exclusion of payment for treatment of Xerostomia, or any other existing medical condition.

Thus BCBS should reimburse me for my prescription expenses on 4/6/08 (75% x $20.99 = $15.74) and provide similar payments while I am a BCBS participant. Thank you for your efforts.

Sincerely,


Larry Bliven

I concur with the medical facts of this letter. _______________________Dr. S.
Attachments: Oral Cancer Foundation article on Xerostomia.
Walgreens Pharmacy Receipt

'01 diagnosis.. jaw hing and base of tongue. surgery not possible. JHU used radiation and chemo to seemingly rid me of the beast. peg for about 19 months. 100 cases of 24 cans of liquid food. 9 months eating therapy. 3x esophagus stretches. non-smoker. previously a social drinker.