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Re: Medicare coverage for all teeth extraction [Re: Tallrific] #193858
02-09-2017 04:52 AM
02-09-2017 04:52 AM
Joined: Dec 2003
Posts: 2,606
Atlanta
U
Uptown Offline
Patient Advocate (old timer, 2000 posts)
Uptown  Offline
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Joined: Dec 2003
Posts: 2,606
Atlanta
I had 8 removed and Medicare paid. They routinely started paying around 2004.


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!
Re: Medicare coverage for all teeth extraction [Re: Tallrific] #193861
02-09-2017 08:27 AM
02-09-2017 08:27 AM
Joined: Jul 2012
Posts: 3,224
NYC
P
PaulB Offline
Patient Advocate (old timer, 2000 posts)
PaulB  Offline
Patient Advocate (old timer, 2000 posts)
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Joined: Jul 2012
Posts: 3,224
NYC
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






Re: Medicare coverage for all teeth extraction [Re: Tallrific] #193863
02-09-2017 10:00 AM
02-09-2017 10:00 AM
Joined: Dec 2003
Posts: 2,606
Atlanta
U
Uptown Offline
Patient Advocate (old timer, 2000 posts)
Uptown  Offline
Patient Advocate (old timer, 2000 posts)
U

Joined: Dec 2003
Posts: 2,606
Atlanta
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 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!
Re: Medicare coverage for all teeth extraction [Re: Tallrific] #193865
02-09-2017 11:16 AM
02-09-2017 11:16 AM
Joined: Jul 2012
Posts: 3,224
NYC
P
PaulB Offline
Patient Advocate (old timer, 2000 posts)
PaulB  Offline
Patient Advocate (old timer, 2000 posts)
P

Joined: Jul 2012
Posts: 3,224
NYC
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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