Blue Cross says no on teeth - Oral Cancer Support

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.

Annabel, I don't think Blue Cross gets to "send your Mother" anywhere. She needs specialized treatment and if there are no specialists [ie-people who do this ALL the time]in network, then she should have any out of network costs covered. Do you have an active State Insurance Commission? If so, talk to them. Amy

Yeah we have an active insurance commissioner that's why our auto insurance rates are going through the roof. I couldn't find anything from the State of Kalifornia about any regulation of medical insurance, omsbudman or anything.

But you can't own a pellet gun in San Francisco. We have a lot of political grandstanders here who don't do sh*t about the real issues. I was born and raised here and I am beginning to hate it here. Our school system here sucks in spite of annual begging for more money. If it wasn't for Mississippi we would ranked #50. Sorry, I'm just having a pity party and venting tonight.

Dear Gary, come see us in Cherokee village [alot of Kalif. folks are moving here] We are really back woods here, but our Ins. Commission took on John Alden Ins. for me and we got paid. Our schools are good and the 1st day of deer season is a holiday, in case you are interested. If not, you can just go play golf or fish that day

Amy

I just shoot targets and people -I don't like harming furry little animals. Golf sounds good however. One of my best friends lives in Arkansas. Plays in a band there. We had a band going Kalifornia for a while. I'll email a link as soon as I find it - they're supposed to be pretty popular there.

I have Blue Cross/Blue Shield Federal and my policy has a specific line that states "restore the mouth to a pre-cancerous state". They did cover both an Iliac crest (hip) implant to my upper jaw and dental implants.

On my initial surgery, an oral surgeon had to pull three teeth prior to the ENT removing my tumor (same surgery room/same day/same time), but blue cross initially denied the dental portion of the claim. I called them and explained that the removal of teeth was an integral part of the cancer surgery and they covered the expenses.

Hopefully your policy reads the same, otherwise shame on them.

My husband will have to get teeth implants because of cancer of the mandible (it was replaced) 3 years ago. Would you believe the insurance co (Anthem blue cross blue shield ) had okayed it last year, but he had to have one more surgery to remove scar tissue from under his tongue this January and now the insurance company is refusing to pay.
I remember years ago, maybe 30 yrs, my friend had to have a double masectamay and her insurance refused it, but they fought the insurance co and they paid for implants. Now what is the difference? I know its a psychological thing more than a needed replacement. My husband's side of his face is caving in a little and it's very difficult for him to eat. People can see that but they can't see someone's breast implants (at least I hope not) lol. I hope I make sense.

I am writing with questions about insurance coverage for dentures after oral cancer, chemo and radiation treatment. I have had dentures for nearly 50 years previous to oral cancer. After treatment, because of adhesions in my mouth, my dentures no longer fit and I had to have new ones made. I have contacted Medicare and they have denied my claim. I sent them letters from my ENT, Oncologist, and Radiation Oncologist, all stating the importance of teeth (in my case dentures) in maintaining good health; for without teeth, one cannot get adequate nutrition to maintain good health. My claim continues to be denied. I also sent letters to Senators in Minnesota requesting that perhaps they could introduce a bill requiring medicare to pay for teeth after oral cancer treatment when it is medically necessary. After all, medicare will pay for a wig, arm or leg prostheses in follow-up to cancer, why not teeth, which are a prosthesis as well. Anyway, does anyone have any suggestions on how to continue in the pursuit of my claim to medicare? Will welcome your input.

1-1/2 year post squamous cell cancer tongue with removal of 2/3 of the right side of my tongue, and neck dissection to the right side of my neck, followed by chemo and radiation.

Kate....Do you have BC/BS? Maybe you should go to the BC/BS headquarters right there in Eagan and ask to talk to a manager in the claims area. Be firm and emphasize the valid points you just mentioned in your forum message. Good luck! JaneP
(we used to live in Eagan, so we know the area)

I never had any luck convincing Cigna or Aetna, don't remember which one I had at the time, to pay for my dentures despite letters from doctors. They were perfectly willing to pay for surgical, rather than dental, removal of the teeth but not one cent for replacement teeth. Said I had to file under dental coverage which has a max of $1800 a year. Teeth are not a medical necessity according to them.

Your points are all valid. Good luck with medicare. See if you can find anything in the writing that says they won't cover this or they only cover it if ...

I find dread the day when I have to go under Medicare having fought some battles with them for my parents.

Good luck and keep fighting.
Eileen

I fought many battles with Anthem Blue Cross/Blue Shield to no avail. They will NOT cover implants nor dentures. Good luck with it.

Thanks for your responses and your input. Will continue to pursue this with Medicare and will contact Blue Cross/Blue Shield as well. I'll keep you posted as to what I hear from them.

Dear Grandma Kate, I don't know how much energy you have, or where you feel it is best spent, but I can tell you that some battles can be won. Having fought several major ones in the past 2 years, I have learned to insist on talking to the highest person on the chain, to get my State Commissioner of Insurance or the Grievance Board involved and to pressure our Docs to get involved in the issue. It does take alot of time and energy and only you can determine if it is worth it.