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Diagnosed with Ameloblastoma

Head & Neck Cancer | Last Active: Sep 10 7:47am | Replies (287)

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Profile picture for sueputnam @sueputnam

I had a 1”x 3” section of lower right mandible removed in 2021 along with a 1”x3” benign unicycistic ameloblastoma cyst, and 3 teeth. The replacement is a 5 tooth permanent bridge with a small space below it for cleaning and future access. My biggest problem was with payment. By the time you get to “benign.” your only thought is to get it out as soon as possible! I had Medicare Advantage PPO Dental Insurance and a Physicians Mutual dental insurance policy. The approximate cost was $10,000 to take it out and $10,000 to fill the hole. Problem was that UHC said it was a dental issue as did PM. It took nearly 4 years of fighting with the insurance companies to prove to them that their own rules define unicycistic ameloblastoma as a medical condition. Of course, if you want definitive answers and course of treatment, payment is due upon receipt of treatment. In the end, UHC came through with $2000 by way of their appeal process.

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Replies to "I had a 1”x 3” section of lower right mandible removed in 2021 along with a..."

Hi @sueputnam I think we should soon require a medical definition of “dental”. I have experienced Medicare rejection of gum tissue ablation as dental, no teeth in that area, only prosthetic. In your case however, an advantage plan is really only an advantage to the insurance company or to those who never get sick. My costs have usually been under $2000 USD under standard Medicare without appeal.