| Joined: Dec 2003 Posts: 2,606 Likes: 2 Patient Advocate (old timer, 2000 posts) | Patient Advocate (old timer, 2000 posts) Joined: Dec 2003 Posts: 2,606 Likes: 2 | I had 8 removed and Medicare paid. They routinely started paying around 2004.
SCC Stage IV, BOT, T2N2bM0 Cisplatin/5FU x 3, 40 days radiation Diagnosis 07/21/03 tx completed 10/08/03 Post Radiation Lower Motor Neuron Syndrome 3/08. Cervical Spinal Stenosis 01/11 Cervical Myelitis 09/12 Thoracic Paraplegia 10/12 Dysautonomia 11/12 Hospice care 09/12-01/13. COPD 01/14 Intermittent CHF 6/15 Feeding tube NPO 03/16 VFI 12/2016 ORN 12/2017 Cardiac Event 06/2018 Bilateral VFI 01/2021 Thoracotomy Bilobectomy 01/2022 Bilateral VFI 05/2022 Total Laryngectomy 01/2023
| | | | Joined: Jul 2012 Posts: 3,267 Likes: 4 Patient Advocate (old timer, 2000 posts) | Patient Advocate (old timer, 2000 posts) Joined: Jul 2012 Posts: 3,267 Likes: 4 | I feel your pain, Murphy. I had 29 teeth extracted at once, as a result of rampant radiation caries that was medically necessary, but was not covered by Medicare being it was after radiation treatment, and not in preparation for radiation or was during surgery to remove neoplastic disease. Here is somewhat dated detailed information that may help you with an appeal or reimbursement is, "Extending Medicare Coverage for Preventive and other Services." In it, there are 5 conditions that are covered, one being Head and Neck Cancer, which is explained in more detail. What is covered are extractions of teeth prior to radiation, oral examination if extractions are to performed. What is not covered is an oral exam if no extractions are to be performed prior to radiation, preventive care to reduce risk of radiation caries (fluoride trays, supplemental topical fluoride, treatment for radiation caries). https://www.ncbi.nlm.nih.gov/books/NBK225261/Here is a more recent report on covered oral care, although less detailed: http://www.medicareadvocacy.org/med...is-coverable-under-current-medicare-law/Good luck
10/09 T1N2bM0 Tonsil 11/09 Taxo Cisp 5-FU, 6 Months Hosp 01/11 35 IMRT 70Gy 7 Wks 06/11 30 HBO 08/11 RND PNI 06/12 SND PNI LVI 08/12 RND Pec Flap IORT 12 Gy 10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux 10/13 SND 10/13 TBO/Angiograph 10/13 RND Carotid Remove IORT 10Gy PNI 12/13 25 Protons 50Gy 6 Wks Carbo 11/14 All Teeth Extract 30 HBO 03/15 Sequestromy Buccal Flap ORN 09/16 Mandibulectomy Fib Flap Sternotomy 04/17 Regraft hypergranulation Donor Site 06/17 Heart Attack Stent 02/19 Finally Cancer Free Took 10 yrs
| | | | Joined: Dec 2003 Posts: 2,606 Likes: 2 Patient Advocate (old timer, 2000 posts) | Patient Advocate (old timer, 2000 posts) Joined: Dec 2003 Posts: 2,606 Likes: 2 | Paul, it took me over 2 years to get mine approved through appeals and even going to the Social Security Oversight Committee Chair and back then the allowable rate was $50/tooth. I was told that was the beginning period for any coverage. Back then, head and neck cancer was also an automatic approval of Social Security Disability. The major university cancer center I was treated at also had a full dental clinic that performed pre-treatment screenings and even provided a post-treatment plan for continued care. Medicare and private insurance started scaling back on what was covered and as everything became exempt, the clinic eventually closed. It seems like the more of us there are, the worse aftercare gets.
SCC Stage IV, BOT, T2N2bM0 Cisplatin/5FU x 3, 40 days radiation Diagnosis 07/21/03 tx completed 10/08/03 Post Radiation Lower Motor Neuron Syndrome 3/08. Cervical Spinal Stenosis 01/11 Cervical Myelitis 09/12 Thoracic Paraplegia 10/12 Dysautonomia 11/12 Hospice care 09/12-01/13. COPD 01/14 Intermittent CHF 6/15 Feeding tube NPO 03/16 VFI 12/2016 ORN 12/2017 Cardiac Event 06/2018 Bilateral VFI 01/2021 Thoracotomy Bilobectomy 01/2022 Bilateral VFI 05/2022 Total Laryngectomy 01/2023
| | | | Joined: Jul 2012 Posts: 3,267 Likes: 4 Patient Advocate (old timer, 2000 posts) | Patient Advocate (old timer, 2000 posts) Joined: Jul 2012 Posts: 3,267 Likes: 4 | It's not right!
When I received SSDI in 2010, I had to wait 29 months from my disability date, 2009, not the filing date, to start receiving medicare in 2012. Initially, I was covered by limited dental care through my employers private dental insurance, which I extended with COBRA for two years once my short and long term disability ended until medicare kicked in, although 29 months is permitted if SS is filed by a specified period. I'm not sure what dental care is allowable through private insurers as far as this medicare rule, and may all differ, although they may be similar to medicare, CMS, since that's who sets most of the paying standards, I think. My pre-treatment dental care was limited to one extraction, filling, and a root canal that my dental insurance covered, so I had pretty good teeth otherwise.
After all my cancer treatments ended in 2014, and had no cancer recurrences for 6 months, I finally had my much needed dental extractions after the 20/10 HBOT, which HBOT was covered, but the surgical extractions weren't. I think my CCC felt sorry for me, a least my dental oncologist there did, so I didn't have a problem with that so far, but the anesthesiologist was looking for $6,000.
I still have no teeth since 2014, mainly due to ORN, Surgeries, and healing times, but dentures or implants, which implants my ENT doubts I can have based on all my radiation treatments totaling over 200Gy, are not covered by medicare, even though my teeth caries/damage was from radiation.
I hope these insurance rules change for post treatment care, and for automatic pre-treatment care without out-of-pocket expense, but doubt it, without an uproar or other event(s).
10/09 T1N2bM0 Tonsil 11/09 Taxo Cisp 5-FU, 6 Months Hosp 01/11 35 IMRT 70Gy 7 Wks 06/11 30 HBO 08/11 RND PNI 06/12 SND PNI LVI 08/12 RND Pec Flap IORT 12 Gy 10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux 10/13 SND 10/13 TBO/Angiograph 10/13 RND Carotid Remove IORT 10Gy PNI 12/13 25 Protons 50Gy 6 Wks Carbo 11/14 All Teeth Extract 30 HBO 03/15 Sequestromy Buccal Flap ORN 09/16 Mandibulectomy Fib Flap Sternotomy 04/17 Regraft hypergranulation Donor Site 06/17 Heart Attack Stent 02/19 Finally Cancer Free Took 10 yrs
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