Hello everyone. I'm trying to get information for my Brother-in-law who is on Medicare and recently diagnosed with stage 3 cancer in his tongue and neck (also 3b lung cancer). He is scheduled to get all his teeth extracted this Thursday prior to starting his radiation treatment the following Monday.

My primary question is, who should be performing the extraction? But also is $4500 a reasonable 20%? That seems very high to me. And should they pay all their responsibility at time of service?

While I don't want to get into my sisters financial business I know they are not wealthy but do not qualify for most financial assistance. I worry they are so wrapped up in dealing with getting him better instead of questioning the costs. From what I've read here on the forum these costs will continue on far beyond the initial Rad and Chemo treatments. I want to help them with information and would greatly appreciate any advice you can share.

Regrettably my youngest brother had throat cancer too but didn't have extraction done before RT and now has only 2 remnants of teeth remaining. Blessings he is currently cancer free. We hope our BIL has better results.

Stay well,
Polly Levatino
Cherry Valley, IL
Two brothers in FL with Cancer - Throat SCC, Lung, Prostate
One brother in FL recovering from Throat SCC

Polly, I had 8 teeth extracted before radiation and back in 2003, Medicare was just beginning to reimburse for this, at the rate of $50/tooth. I had the oral surgeon come in while I was under general anesthesia, getting my PEG and portacath put in at the same time.

Regarding cutting back or saving costs, your approach would have one questioning every procedure and maybe opting out of some, in hopes of reducing the overall bill. I don't think it is realistic and unless you can perform or provide the service, I'm not sure it's the best decision, either. I assume this care is from a major cancer center as well. The treatment protocols are standardized, in a sense, with the allied health requirements determined before treatment begins.

Hi Uptown - I appreciate your feedback. No the services are not at a Cancer Center. Just found out they will be thru an Oral Surgeon though. Apparently they waited a week for the FL Cancer Center to refer them and finally went out on their own instead of waiting any longer.

I do realize the urgency of the treatment and I'm not suggesting they go something drastic like get 3 quotes for services or anything of the sort. They just don't know what they don't know and I was hoping people here could offer guidance from their experiences. Thanks again for sharing yours.

Although I didn't have Medicare when I first had radiation, and had two teeth extracted, it is to my understanding that Medicare covers extractions if it is needed to have done in order to have cancer treatment, and is not usually covered after treatment, when it is then considered cosmetic.

The 20% sounds like what Medicare A, B, doesn't cover, unless you have secondary insurance or a Medicare supplemental plan. Medicaid, if one can qualify, apparently covers dental, and some are able to get dual coverage with Medicare and Medicaid.

Also, the usual wait time for a tooth extraction is usually 21 days, depending on healing, before starting radiation treatment, although some doctors believe two weeks is enough, and in event of anything sooner, prophylactic antibiotics, as a precaution, may be needed in thinking that effects of radiation don't start until 10-14 days after starting, and healing should be complete, but chemo effects start a few days after infusion. One may need dental clearance, I did, before starting radiation treatment after extractions.

Good luck with everything.

Having all the teeth removed on a Thursday and beginning radiation the following Monday does NOT sound right! Ive had all of my teeth extracted and it hurts like heck! The patient needs a good 2-6 weeks to heal from something so drastic. Radiation treatments can complicate matters and cause some major issues with healing.

Although they opted not to get treated at a CCC, it sure wouldnt be a bad idea to reexamine that idea. A CCC will understand the risks involved with this and be better prepared.

Im hoping having all the teeth removed will be done in a hospital rather than at the office. The costs do sound high but Im not familiar with the exact costs of this type of procedure. When I had mine removed I was kept overnight in the hospital and they worked with me on the charges. Many hospitals will have special programs to help uninsured or underinsured patients. Some will even offer charity care for lower income patients. They must ask for this, its not always offered to patients.

Best wishes!

I had 8 back teeth taken out on Saturday, overnight in the hospital and rads started Wednesday.

Hello and sorry you have to be here. The dental industry is nearly as squishing and foggy as the medical industry. It is very hard to get to the truth of reimbursements and such.

The general time between extractions and radiation is about three weeks. My impression was it was better to have the gums healing up pretty well before starting rads.

Generally, three weeks delay to start rads is pretty typical too. Often times it is longer between diagnosis and treatment.

Unless the doctors state the need for urgency you can slow it down. You just need to speak up and ask to reschedule. I did this when I finished induction TPF and said hold on, I need more time to recover before starting chemo-rads. It was two-three weeks delay and I felt so much better going into rads it was certainly worth it for me.

Good luck

I had my upper teeth extracted and was fitted for dentures. I went back 2 weeks later to have the dentures adjusted and this is when they discovered my tongue cancer. After I healed from surgery I had to have a bottom tooth extracted before radiation started. I had to wait 3 weeks for the extraction site to completely heal before they would start radiation.

I had 22 teeth extracted prior to radiation for tongue cancer, Blue Cross Blue Shield would not cover it! Said that was a dental procedure. $2300.00 out of pocket !!!

Having teeth removed is a dental procedure but because it was necessary due to cancer it should be a medical procedure. Was this done in a hospital? I also had many teeth removed because of being weakened so much by rads they were all loose and needed to be removed. Mine was a different situation as it was after I had rads. I had very good medical and dental insurance at the time and was not billed one cent. I would appeal it and talk to the doctors office about rebilling it with medical codes.

I had 8 removed and Medicare paid. They routinely started paying around 2004.

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

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.

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).