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Joined: Aug 2014
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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

Last edited by Tallrific; 09-01-2014 05:59 AM.

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


SCC Stage IV
BOT primary
T2N2bM0
Cisplatin/5FU x 3
40 days radiation at 4 sites
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.
PLS 02/13
COPD 01/14
Intermittent CHF 6/15
Feeding tube NPO 03/16
VFI 12/2016
ORN 12/
Osteoporosis 01/2018
Heart attack 06_2018

Living life LARGE with no quit in this guy!
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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.


Polly Levatino
Cherry Valley, IL
Two brothers in FL with Cancer - Throat SCC, Lung, Prostate
One brother in FL recovering from Throat SCC
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Posts: 3,267
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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.


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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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!


Christine
SCC 6/15/07 L chk & by L molar both Stag I, age44
2x cispltn-35 IMRT end 9/27/07
-65 lbs in 2 mo, no caregvr
Clear PET 1/08
4/4/08 recur L chk Stag I
surg 4/16/08 clr marg
215 HBO dives
3/09 teeth out, trismus
7/2/09 recur, Stg IV
8/24/09 trach, ND, mandiblctmy
3wks medicly inducd coma
2 mo xtended hospital stay, ICU & burn unit
PICC line IV antibx 8 mo
10/4/10, 2/14/11 reconst surg
OC 3x in 3 years
very happy to be alive smile
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I had 8 back teeth taken out on Saturday, overnight in the hospital and rads started Wednesday.


SCC Stage IV
BOT primary
T2N2bM0
Cisplatin/5FU x 3
40 days radiation at 4 sites
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.
PLS 02/13
COPD 01/14
Intermittent CHF 6/15
Feeding tube NPO 03/16
VFI 12/2016
ORN 12/
Osteoporosis 01/2018
Heart attack 06_2018

Living life LARGE with no quit in this guy!
Joined: Jan 2013
Posts: 1,291
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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


Don
Male, 57 - Great health except C
Dec '12
DX: BOT SCC T2N2bMx, Stage 4a, HPV+, multiple nodes
1 tooth out
Jan '13
2nd tooth out
Tumor Board -induction TPF (3 cycles), seq CRT
4-6/2013
CRT 70gr 2x35, weekly carbo150
ended 5/29,6/4
All the details, join at http://beatdown.cognacom.com
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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.

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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 !!!


5/31/16 Partial Glossectomy
Right neck dissection
22 teeth extracted
Six weeks of radiation Ended 8/19/16
2/8/17 Biopsy of epiglottis-cancerous
35 radiation treatments to the throat, End 11/17/17
8/23/19 Tongue reconstruction, left radical neck dissection
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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.


Christine
SCC 6/15/07 L chk & by L molar both Stag I, age44
2x cispltn-35 IMRT end 9/27/07
-65 lbs in 2 mo, no caregvr
Clear PET 1/08
4/4/08 recur L chk Stag I
surg 4/16/08 clr marg
215 HBO dives
3/09 teeth out, trismus
7/2/09 recur, Stg IV
8/24/09 trach, ND, mandiblctmy
3wks medicly inducd coma
2 mo xtended hospital stay, ICU & burn unit
PICC line IV antibx 8 mo
10/4/10, 2/14/11 reconst surg
OC 3x in 3 years
very happy to be alive smile
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