The May bulletin [AARP mag] has a story about a 78 yr. old woman who lost parts of "her tongue, neck and mouth " during surgery for squamous cell cancer. While she fully expected Medicare to pay for her new dentures -$1400.00- they have refused, siting that it was a dental-not a medical problem. After an appeal to an administrative law judge was turned down, AARP attorneys along with several other Advocacy groups are now joining together to bring a lawsuit challanging the way Medicare appeals are being handled.

Amy, I hope the AARP can straighten out a few things. Although I was not dealing with Medicare, it was the Bank of Joanna who paid for implants made necessary by the radiation, when the medical insurance said it was a dental problem and the dental insurance said no, it was medical. I do believe the insurance companies are in league with one another!

And it was the Bank of Eileen who paid $15,000 for partials made necessary by teeth pulled prior to radiation. Medical said it was a dental problem even though medical paid the surgical expense to remove them. It don't think it was the appeals process for Medicare that got this denied. I just don't think most medical insurance is willing to pay for dentures or implants even as a result of medical necessity.

Take care,
Eileen