Mom's dentist, at the same institution where she was treated for cancer, said that radiation treatment caused a whole bunch of cavities. From what I've read online, increased incidence of cavities isn't out of the ordinary. I was wondering if anyone had luck with Medicare, or any other insurance, paying for cavities. Thanks.
Dave

Dave, since John's teeth were pulled, I can't address the cavity issue- But, I would have her Dentist write a report to the effect that radiation has caused serious problems with her teeth that need to be addressed before the condition deteriorates further. Jerry might help with the wording. Then I would call her Ins. Co. and speak to them in technical terms and tell them you have this report and need to know who to send it to.Have you had any success with her other issues? Amy

Been thru the process and you have to build a case that the work on your teeth was medically necessary. Seems obvious but you have to prove it. I put together file of letters from dentist, and rest of my medical team and sent letter to insurance company. Followed up with phone calls and additional update letters. Was turned down once as there dentist said this was cosmetic process. That was the mistake - stupid! After one year was reimbursed 100% for all the work. Don't give up, get the letters and follow up. Good luck.

Hi Dave,

Dealing with insurance companies is one of the most difficult and frustrating tasks that I know of. I have a full time employee that handles insurance and she spends most of her time dealing with this problem. Insurance companies are in the business of making money, not spending it (on paying claims, that is). They spend their money on the top dogs and on their monumental buildings. Have you ever seen a shabby insurance company building? I guess you can see how I feel about them.

Even though a claim is denied, it doesn't mean it won't eventually be paid. The first step is to try to talk to a supervisor. Most service reps that get your phone calls are very good at stonewalling you, but persistence will pay off most of the time. Another thing you need to do if coverage is denied, is to get the exact wording from the policy that they are using to deny the claim. Get it in writing. At this point, you may find that there is no chance if the wording is specific. Most of the time it will be vague and then it is worth persuing the problem further.

Check out this link on this website for some good background information about the relationship of radiation, salivary glands and decay: http://www.oralcancerfoundation.org/dental/dental-complications.htm

Len has some very good advice in his email and perhaps if you get to the stage of collecting supportive letters from dentists, etc. you might be able to get copies of his.

Good luck and let me know if there is anything I can do.

Jerry

Thanks, everyone! JAM, things are going okay w/the other issues. Yesterday we had her throat dialated again...the third or fourth time since tx ended as she's still tube feeding. Hopefully she'll be able to begin eating orally again. Psychologically, post treatment, she's a bit different than she was before she got sick. She doesn't seem to want to take charge or be too independent. Doesn't want to make decisions whatsoever. It's odd for me, perhaps because I have no medical training or understanding of psychological/psychiatric issues, to watch someone fight so hard and survive an extremely aggressive tx only to be very blase post tx. In a nutshell, it's an ongoing recovery with many components at issue. Sorry for getting off topic.

Did she go the distance with oral hygiene care to the point of obsession, which is a requirement, for keeping your teeth & gums healthy. Radiation, in itself typically won't kill or damage your teeth. It's the lack of saliva that does the greatest harm. Did she have dental trays made? Did she do almost daily, at home, flouride treatments with presciption strength flouride? Teeth cleaning 3-4 times a year? Water Pik, floss after every meal? ALL throughout treatment.

Dental insurance should cover cavity (carrie) repairs.

Good questions, I'll have to check. Given that she hasn't been using her Therabyte regularly, to the point that the dentist can't get in her mouth to do a complete exam (the cavities he found are on her front teeth), my guess is that she hasn't been as diligent as she should be.

Didier, I feel for your Mom. My hunch is she is not blase- but really tired and I don't blame her for not wanting to make decisions that someone else could handle. My experience as a caregiver is that, for several months early on, I under-estimated the mental and physical energy John was putting forth just to get through the treatments. The energy that is required of him now, to try to survive is unmeasureable. As a caregiver, you must be tired also. Hope you are taking care of yourself. Amy

Didier...maybe she was not as diligent as she could have been but, asking her those questions now, after the fact, can only make her feel bad. She has enough to worry about.
Bless you for being so diligent for her and your dad.
Marica

Didier,
I didn't pose those questions for you to confront her about it, just that knowledge is power and insurance coverage is a multidimensional thing. Your original question concerned the Medicare coverage aspect it. The trimus element is also a consideration. You have to have your ducks lined up when you confront insurance companies.

In all fairness to your mother, it took me an extraordinary committment to daily oral hygiene - and still does. The risk of ORN is for LIFE. It's like the PEG or treatment options - you have to carefully weigh out the risks and benefits of all the choices and make decisions based on that and what is achievable in reality. A relentless support system is an integral component of this.

The front teeth teeth are pretty tough, the back teeth are probably in much worse shape. I sure that Jerry can elaborate more on this.

Thanks everyone. The reason I may sound a little rough around the edges at this point is because three of her doctors have contacted me and basically said that she really needs to be more responsible for herself. I realize there are many factors to recovery that are challenging -- both physically and emotionally.
For the longest time I coddled her and that clearly didn't help the situation. I let up on the reigns some time last year in an effort to get her to start living again. Shortly after treatment she was honestly doing quite well -- driving and working a bit. Then she stopped everything: driving, walking, working, keeping herself clean, taking care of her pets, etc. She was medicating herself and calling different doctors complaining of different ailments in order to get all sorts of meds -- including morphine. This wasn't a pretty picture. I finally got that under control with the help of some docs and by adapting my caregiving technique. I've toughened up, I've had to. I honestly belive that had I allowed her behavior to continue, and if I continued babying her, she would be in a much darker place. Perhaps I was overprotective and, as a result, I am partially responsible for some of her behavior. I don't know. Wo. Way off topic, but I felt the need to explain.

Dave,

Don't be too hard on yourself or your mom. Much of the stuff patients and caregivers go through after such a traumatic period is different in every situation and for every person. Just remember that you both did what you needed to do at the time. You were great in all you did and especially with both of you having to deal with your father's issues and ultimate passing. I remember well how tough things were for you.

I read some of my file at the doctor's office today looking for something and saw and the glorious remarks about how well I cared for my teeth and mouth and how horrible it would be to not follow through with repair work after radiation with big bolded letters saying "LIFE OR DEATH" and I was stunned when the insurance company said it was only cosmetic and they would not pay a penny. I fought for two years to cover the back teeth that were pulled out pre-treatment, even though it was only a few hundred bucks. I am now preparing for the battle to finish this last piece of business!

Hang in there, if you don't fight, they win without effort.

Greetings from me, by the way,

Ed

Didier, Ed is so right - you must not second-guess your actions. Having been caregiver for both my mom and dad too, there are certainly things I wish I had done differently, but I am at peace knowing that I did the best that I could, and what I thought was best, at the time. We find ourselves put in a role for which most of us have no training. From where I sit, I think you must be applauded for doing, and continuing to do, a most remarkable job. The strength and compassion you have shown over this long, long, haul set you apart from many. Your parents did something very right that you have been so dedicated in caring for them. I didn't understand as a child when my grandmother would talk about people earning stars for their crown, but I do now and you must have hundreds!

Thanks, everyone. I truly love you guys. You have no idea how much help you've been over the past few years. You've been my shrink, my friend, my educational resource and more. Thanks again.

Best regards,

Dave