#67938 01-20-2008 05:02 AM | Joined: Jan 2008 Posts: 82 Senior Member (75+ posts) | OP  Senior Member (75+ posts)
Joined: Jan 2008 Posts: 82 | I have been using Jevity 1.5 since October, however my insurance provider does not cover this. They cover TPN and other types, but I am being told that the state of Georgia, in its infinite wisdom chose a program that does not cover this type of nutritional supplement. I have written the State Insurance Commissioner, the company's office in Salt Lake City (am I allowed to mention their name here? I would love to spread it all over the earth so we can help others with similar problems), and have gotten responses from both; the Commissioner has an investigator assigned to my case, the company has replied stating very clearly that they will NOT cover any of the enteric materials...even thought it is my lifeblood for sustenance, and offered me a second appeal... which I have taken... additionally my primary care physician has written an appeal as well. This is one that I will not sit back and idly watch. Anyone having similar problems? We pay and pay and pay and they take and take and take...
John - Proud to be here...
Hemiglossectomy 08/02/07, 4 lower molars extracted prior to 6 weeks IMRT 09/10/07-10/19/07, SCC w/met to L neck lymph nodes, rad only, no ND. PEG 10/26/07-02/05/08.
"We're all in the same boat in a stormy sea, therefore we owe one another a terrible loyalty."
| | | | | Joined: Jun 2007 Posts: 10,507 Likes: 7 Administrator, Director of Patient Support Services Patient Advocate (old timer, 2000 posts) | | Administrator, Director of Patient Support Services Patient Advocate (old timer, 2000 posts)
Joined: Jun 2007 Posts: 10,507 Likes: 7 |
John:
Im sorry to hear your feedings arent covered. From what my doctors explained to me, very few insurance companies cover it. The insurance companies look at the liquid feeding as something the patient should buy. Their views are since the patient doesnt buy food, then they can buy this. I had a little bit of a problem getting mine covered. All the accessories were ok, but not the cans of feed, I use Two-Cal. Somehow the nurses worked some magic and contacted both my insurance company and also the medical supply place and mine is covered. Its also could vary by state. I wish you luck in getting it covered.
ChristineSCC 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  | | | | | Joined: Sep 2006 Posts: 8,311 Senior Patient Advocate Patient Advocate (old timer, 2000 posts) | | Senior Patient Advocate Patient Advocate (old timer, 2000 posts)
Joined: Sep 2006 Posts: 8,311 | I was tested and told by Moffitt doctors that I suffered permanent high frequency hearing loss from the Cisplatin and that I would benefit from hearing aids. I was also told my insurance would not cover them and I haven't pressed it yet (cause I'm way to young Jim for hearing aids) but that is baffling to me as well. I don't see any difference between loosing my teeth from radiation and loosing my hearing from chemo?
David
Age 58 at Dx, HPV16+ SCC, Stage IV BOT+2 nodes, non smoker, casual drinker, exercise nut, Cisplatin x 3 & concurrent IMRT x 35,(70 Gy), no surgery, no Peg, Tx at Moffitt over Aug 06. Jun 07, back to riding my bike 100 miles a wk. Now doing 12 Spin classes and 60 outdoor miles per wk. Nov 13 completed Hilly Century ride for Cancer, 104 miles, 1st Place in my age group. Apr 2014 & 15, Spun for 9 straight hrs to raise $$ for YMCA's Livestrong Program. Certified Spin Instructor Jun 2014.
| | | | | Joined: Jun 2007 Posts: 5,260 Patient Advocate (old timer, 2000 posts) | | Patient Advocate (old timer, 2000 posts)
Joined: Jun 2007 Posts: 5,260 | LOL David,, even at my advanced age I don't wear hearing aids either. But I would appreciate very much for them to pay for a set of teeth when I am ready for them. They paid to have them removed with no problem. Yes David,, you are still a kid, LOL at least in heart.
Since posting this. UPMC, Pittsburgh, Oct 2011 until Jan. I averaged about 2 to 3 surgeries a week there. w Can't have jaw made as bone is deteroriating steaily that is left in jaw. Mersa is to blame. Feeding tube . Had trach for 4mos. Got it out April.
--- Passed away 5/14/14, will be greatly missed by everyone here
| | | | | Joined: Jan 2008 Posts: 82 Senior Member (75+ posts) | | OP Senior Member (75+ posts)
Joined: Jan 2008 Posts: 82 | Well, I'll be darned... never thought of it like that. I suppose they believe they are justified... since I'm not able to eat normal food like a normal person, I must pay for what's recommended, whether I like it or not. Since I'm not paying for regular food, I still get to deduct it from my family's grocery bill... this chaps my rear! Big time! I realize by virtue of being on this site, I have other concerns on which to focus, but as a matter of principle I think it is BS, and I have every intention of carrying this as high as necessary to get some sort of resolution... oh well, I could bitch and bitch, but I've better things to do... like talk to you guys for one.
John - Proud to be here...
Hemiglossectomy 08/02/07, 4 lower molars extracted prior to 6 weeks IMRT 09/10/07-10/19/07, SCC w/met to L neck lymph nodes, rad only, no ND. PEG 10/26/07-02/05/08.
"We're all in the same boat in a stormy sea, therefore we owe one another a terrible loyalty."
| | | | | Joined: May 2002 Posts: 2,152 Patient Advocate (old timer, 2000 posts) | | Patient Advocate (old timer, 2000 posts)
Joined: May 2002 Posts: 2,152 | Good luck at getting the insurance company to pay for replacing the teeth. They paid to pull mine but when it came to replacing them, no way. They also refused to pay for the cans of whatever I had to ingest after the TL surgery. Same deal, said it is food. Fight on John!
Take care,
Eileen
----------------------
Aug 1997 unknown primary, Stage III
mets to 1 lymph node in neck; rt ND, 36 XRT rad
Aug 2001 tiny tumor on larynx, Stage I total laryngectomy; left ND
June 5, 2010 dx early stage breast cancer
June 9, 2011 SCC 1.5 cm hypo pharynx, 70% P-16 positive, no mets, Stage I
| | | | | Joined: Jun 2007 Posts: 5,260 Patient Advocate (old timer, 2000 posts) | | Patient Advocate (old timer, 2000 posts)
Joined: Jun 2007 Posts: 5,260 | Good luck John and I for 1 will be watching for how this turns out . I hope you win this round 10-0
Since posting this. UPMC, Pittsburgh, Oct 2011 until Jan. I averaged about 2 to 3 surgeries a week there. w Can't have jaw made as bone is deteroriating steaily that is left in jaw. Mersa is to blame. Feeding tube . Had trach for 4mos. Got it out April.
--- Passed away 5/14/14, will be greatly missed by everyone here
| | | | | Joined: Sep 2006 Posts: 8,311 Senior Patient Advocate Patient Advocate (old timer, 2000 posts) | | Senior Patient Advocate Patient Advocate (old timer, 2000 posts)
Joined: Sep 2006 Posts: 8,311 | Help me here...what do they say is the reason not to replace the teeth they just paid to remove?
David
Age 58 at Dx, HPV16+ SCC, Stage IV BOT+2 nodes, non smoker, casual drinker, exercise nut, Cisplatin x 3 & concurrent IMRT x 35,(70 Gy), no surgery, no Peg, Tx at Moffitt over Aug 06. Jun 07, back to riding my bike 100 miles a wk. Now doing 12 Spin classes and 60 outdoor miles per wk. Nov 13 completed Hilly Century ride for Cancer, 104 miles, 1st Place in my age group. Apr 2014 & 15, Spun for 9 straight hrs to raise $$ for YMCA's Livestrong Program. Certified Spin Instructor Jun 2014.
| | | | | Joined: Aug 2007 Posts: 580 "Above & Beyond" Member (500+ posts) | | "Above & Beyond" Member (500+ posts)
Joined: Aug 2007 Posts: 580 | This is a new twist for me to hear about.
In Canada, insurance companies usually only refuse to pay to raplace teeth that were congenitally missing or extracted before the patient was covered by their companies plan. They use the,"Pre-existing Condition" Clause to justify this. Some Dental Insurance policies do not allow or cover, "Major Restorative", dental work. Major restorative usually includes, posts, dentures, partial dentures, inlays, veneers, crowns, fixed bridges and implants. So, if there is no major restorative coverage you would not be covered for replacement of teeth.
If I assume your plan was comprehensive, you should have some major restorative coverage and therefore should have some coverage for tooth replacement.
It may be worthwhile to review your plan details and then call the company. If you are not happy with what they tell you ask for the contact information of the companies Ombudsman office and write them a letter.
Cheers,
Mike
Dentist since 1995, 12 year Cancer Survivor, Father, Husband, Thankful to so many who supported me on my journey so far, and more than happy to comfort a friend.
Live, Laugh, Love & Learn.
| | | | | Joined: Jan 2008 Posts: 82 Senior Member (75+ posts) | | OP Senior Member (75+ posts)
Joined: Jan 2008 Posts: 82 | Hi guys, Mike, Jim, David, Eileen, n' Christine,
I only had four teeth pulled, bottom molars, and already have replaced with partials thinking I would be eating by Thanksgiving! Heck, I wasn't eating New Years, and can only handle soups and such now! I'm the one who is unhappy with my insurance provider for not covering the Jevity... they will cover TPN feedings at $2000/day, but not a $40 case of liquid supplement... it's really a matter of principle more than anything...geez, go figure... Jim I hope you do well with all those new choppers, pal (whenever they're ready)! Keep us posted, and I'll keep the rest of you posted on those who won't cover my juice.
John - Proud to be here...
Hemiglossectomy 08/02/07, 4 lower molars extracted prior to 6 weeks IMRT 09/10/07-10/19/07, SCC w/met to L neck lymph nodes, rad only, no ND. PEG 10/26/07-02/05/08.
"We're all in the same boat in a stormy sea, therefore we owe one another a terrible loyalty."
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