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Dental treatment before rad denied by insurance
Hi-
I'm not sure if this is the right forum for this. I'm a 53yoM with SCC of the tongue. I completed chemo/radiation at Mayo. Prior to the treatment they required dental examination, building a radiation shield and create flouride treatment trays to use after treatment.
My insurance Blue Cross Blue shield of MN has denied the claim. I then provided them with the letter from Mayo saying that this was needed and they had one of the physicians on their payroll review it and that person served it not medically necessary.
Has anyone else dealt with this situation successfully?
Thank you!
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For me, Aetna paid for the dental exam and tongue deviating stent. They did not cover the fluoride trays.
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1 ReactionI was part of a clinical trial study for the mouth stent that was used during my radiation treatments. My insurance did not pay for the fluoride trays.
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1 Reaction@bmora
I had a similar cancer. Prior to treatment , I had 4 teeth pulled and fluoride trays made. I had to pay $2600 as nothing was covered. I found that the fluoride made me ill so I hardly used it. Now the dentist wants to put in a post for an implant but I’ m not able to afford the $5K bill at this point.
@scottmcf1431
Is there a dental school near where you live? They might be able to provide the services you need at a reduced price.
@scottmcf1431 Did u ask ur Radiation Dr. about putting a post in? A bridge is about $1200 or a flipper is about $600. Radiated bone doesn’t like to heal. That could cause more serious problems.
Things have definitely changed in the 19 years since I underwent treatment. The only thing considered an option at the time was having all my teeth removed to avoid later removals; not something I even considered They did warn me to take good care of my teeth if I wanted to keep them, and that is exactly what I have done, with semi-annual dentist visits, brushing after every meal, a water pick and a prescription fluoride toothpaste in the evening, and Biotene mouth rinse throughout the day. Of course, genetics plays a role in how well one's teeth will do. Good luck!
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1 ReactionPretty much the same thing for me. Had 4 teeth pulled prior to Radiation then the fluoride trays. Insurance would not cover even after many letters from my doctor that it was all medically needed, I used the trays for a year then started doing it every other day. Now I have stopped because I just got tired of the routine. So far so good but don’t know what I will do should I get a tooth ache because since the surgery and radiation I can only get my mouth open about an inch and don’t see how a dentist will be able to do anything.
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2 Reactions@selayedath, this must have been so frustrating. Am I understanding that you ultimately proceeded with treatment without the dental exam?
When dealing with insurance issues, you might also consider talking with an Oncology Social Worker. They can help navigate these complicated situations. Here’s an article Mayo social workers wrote describing the different ways they support cancer patients.
- How an Oncology Social Worker Can Help https://connect.mayoclinic.org/blog/cancer-education-center/newsfeed-post/how-an-oncology-social-worker-can-help/
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1 Reaction@colleenyoung No, I did get the treatment and have a 3k bill now.
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1 ReactionI got no warning of what or how much the radiation would affect my bone/teeth. Reminder to self; No matter, I'm grateful to be alive... Several years later, my teeth were breaking just eating cheerios. I had to undergo weeks of HBO therapy so my jaw wouldn't fall apart before having all of my teeth removed. No matter the cost I still have my life. I paid it off a little at a time, just grateful to be alive.
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