| | Joined: Jun 2009 Posts: 440 Platinum Member (300+ posts) | OP  Platinum Member (300+ posts)
Joined: Jun 2009 Posts: 440 | 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
| | | | | Joined: Mar 2009 Posts: 147 Senior Member (100+ posts) | | Senior Member (100+ posts)
Joined: Mar 2009 Posts: 147 | 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
| | | | | Joined: Mar 2008 Posts: 3,082 Patient Advocate (old timer, 2000 posts) | | Patient Advocate (old timer, 2000 posts)
Joined: Mar 2008 Posts: 3,082 | 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
| | | | | Joined: Jul 2008 Posts: 507 "Above & Beyond" Member (500+ posts) | | "Above & Beyond" Member (500+ posts)
Joined: Jul 2008 Posts: 507 | 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
| | | | | Joined: Jun 2009 Posts: 440 Platinum Member (300+ posts) | | OP Platinum Member (300+ posts)
Joined: Jun 2009 Posts: 440 | 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
| | | | | Joined: Jul 2008 Posts: 507 "Above & Beyond" Member (500+ posts) | | "Above & Beyond" Member (500+ posts)
Joined: Jul 2008 Posts: 507 | 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
| | | | | Joined: May 2002 Posts: 2,152 Patient Advocate (old timer, 2000 posts) | | Patient Advocate (old timer, 2000 posts)
Joined: May 2002 Posts: 2,152 | 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
| | | | | Joined: Jun 2009 Posts: 440 Platinum Member (300+ posts) | | OP Platinum Member (300+ posts)
Joined: Jun 2009 Posts: 440 | 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
| | | | | Joined: Jan 2010 Posts: 13 Member | | Member
Joined: Jan 2010 Posts: 13 | 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
| | | | | Joined: Apr 2009 Posts: 104 Senior Member (100+ posts) | | Senior Member (100+ posts)
Joined: Apr 2009 Posts: 104 | 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
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