Hello, It has been 2 years since I was last on ths site. My mom beat the oral cancer but at a very great cost. I see my questions about teeth from a while back and those questions are still valid. Today Blue Cross said no. I am collecting letters from all her doctors: cancer, plastics, general dr. ect and will be writing to the HMO as well. I have no team or help in this, it is just her and I. Nobody ever took any intrest in her mouth or teeth. She has no bottom teeth beacuse they took the jaw bone and reconstructed it with her leg. Her upper teeth are disenigrating because her mouth is not longer hospitable for real teeth. She is feeling good and looking forward to the future for the first tme in a while. Are there any agenicies that can help..or guide me in fighting with the HMO?? thanx

In my area there was an Ombudsmen that was available to me to fight the insurance company. I have Blue Cross also, and they refused to pay for implants, and never changed their minds. Not sure how they are about dentures. I ended up catching the interest of a very wealthy local man that my husband had become friends with. He is helping us pay for the implants that will put in a week from today.

I know how your mother is feeling right now. She's ready to move on with life but that's difficult to do when you're left so changed and different. It's impossible to NOT think about cancer when the physical changes affect the fundamental act of eating. I never realized what an impact eating had on our day to day lives. Someone should write a book on it!

I wish you and your mom luck with this.
Minnie

Go back and read your Mom's Ins. policy word for word. In John's policy there is a sentence that reads as follows: "We will cover charges required for repair or replacement of sound natural teeth damaged during a course of treatment related to a disease process which occurs and is treated while insured" If you can find any wording to that effect, you can fight them. Also, appeal to your State Insurance Commission for help with the claim. You might consider exploring some Church or other organization fundraisers to start an account to pay for implants or dentures. Good Luck. Amy

I am so happy to hear that someone has given you a gift of kindness and help out with the teeth. I had a feeling that when it came to implants we were going to hit the wall with blue cross. Still, she and I have hope and unending persistance that we will be successfull. thank you for the response...

annabel

I have Blue Cross/Blue Shield and in the policy it states that they will replace natural teeth being lost due to an accident but NOT due to disease. Can you believe that?? I have said many times that if I had gone out, gotten drunk, wrapped my car around a tree and knocked all my teeth out............they would pay for my implants. But, since it's cancer, they won't!

I have heard from many that BC/BS is the worst insurance out there. This is just yet another confirmation of that. Will they pay for HBO if she has to have the uppers extracted?

Amy, who is your carrier? I would imagine Aetna.

I wouldn't let them get away with this.

Periodontal disease and poor hygiene are one thing. I can understand their rationale to not replace teeth lost due to disease for these reasons.

Losing your (otherwise healthy) teeth because they were extracted in a hospital as part of cancer treatment should be another matter.

I wonder if there is an attorney out there that would like to take this on. In my opinion the teeth are not lost due to disease, rather the "accidental" damage due to treatments. I know it might be a stretch but good attorneys stretch words all the time....

John's Ins co. was John Alden-recently acquired by Assurant Health. Keep in mind that we did not get to pursue this issue with John Alden because they dropped John when he was accepted for Soc Security Disability. I have no idea what kind of fight we might have had since we fought about so many other claims related to John's treament. Amy

Gary, BC/BS paid for my HBO treatment when I had it a couple years ago, BUT I had to pay a $40 specialty co-pay EACH time I went. HBO treatment is usually 20-30 "dives" so that adds up. I am having implants done this Tuesday and will need 10 more dives...........so that will cost me $400. Crazy. I argued with them last time because I felt like it should be looked at as "one" treatment, or an ongoing treatment. They did the same thing to me with radiation, charging a daily co-pay.

Thank you all for your advice. I am having BC mail me the coverage booklet so I can scour the language for anything helpfull. BC would only have to deal with the bottom jaw and ony those teeth. The top jaw will be covered by her dental insurence no problem. She has a compromised airway now so if they have to put her under for any reason she must be in a hospital. We found this out on the last surgury in January. The plastic surgen who put her jaw back on felt that there may be some bone shaving needed when the time came for teeth, so there would be a good fit. I just am so fearfull that BC, if they do say ok, won't send her to someone that understands the situation. It took a while to find a dentist who would even clean her teeth. They were afraid of her and look at her like some oddity. Oh, here is her stats : Squamous Cell right mandible, stadge 3, right side of jaw removed & replaced with leg bone, 2/3 tounge removed. No radiation. 2yrs 4 months survivor. Her name is Lee. It was all done and Loma Linda in California.