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How to make health ins.pay for a dental procedure caused by surgery for cancer

After cancer surgery of the head,neck,and jaw,I began to have trouble with dentures fitting after two more full sets of dentures multiple realignments, my personal MD said that several implants were needed upper and lower to anchor the dentures, my dentist states that medical is responsible for covering this procedure.I have no dental insur.,I am now on medical disability &want to return to work, but until this is resolved I don't go out in public much, and certainly would not apply for a job when there is always the possibility that my lower plate may move while I talk, ormy upper plate come almost out of my mouth if I laugh,sneeze or cough. The dental department at MDAH in Houston can do the procedure, several implants 3-4 both upper & lower and a set of upper and lower plates that ""SNAP" in place. I know there are others who have had to fight there insurance (Medical/Health) to pay for a dental procedure to be covered. I would appreciate answers/methods they used successfully, any ICD-9 codes that woked for them. my insurance co. is Aetna Health Ins. (I have no dental ins.) Would like to hear any diagnosis's that would work , I'm becoming very frustrated and need help.                                                 thanks                                     please respond as soon as possible todays date is 11-10-2009


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LB
10 helpful answers

While I don't know what coverage you have, I believe that dentures would be considered "cosmetic," and therefore not covered under health insurance.  Having said that, I've seen policies that cover procedures (in one case, a young woman was involved in an automobile accident and her teeth were all knocked out, requiring major dental surgery, the insurance company actually declined the claim, but it was resolved in her favor after a lengthy time proving it was due directly to the accident.)  You may want to review your policy manual discussing coverage for cancer treatments, (it may even fall into the category of permitted coverage for a prosthetic device or devices), the scope of coverage for major medical procedures (again, this would be directly related to the cancer and treatment, and it's also a good idea to get a letter from all your treating physician(s) that specifically describes your condition and states with absolute certainty that this is a direct result of the cancer, it is required and is part of the process of treating and completing your cancer treatment, and that prior to your cancer and the surgery, the condition did not exist).  I would also read through their cosmetic exclusions to ensure that you don't inadvertently use the wrong language in your claim that would bump it into that category if in fact again you have all the substantiation as above.  One case I heard of involved someone who filed a claim for something, and the letter stated that her condition was being "managed" with medication, which is a medical "term of art," but was misinterpreted by the insurance company as meaning that this medication "fixed" the problem, thus denying further coverage.  I hope that example is helpful as well as the above.  Good luck to you on that, I will be keeping you in my thoughts.  Please try not to hide out though because you are afraid of how people will look at you - I've had a chronic illness for 4 years that has to me a profound affect on the way I look, but I learned a few hard lessons after I isolated for three of these:  (1)  The longer you isolate, the harder it is to get back out; (2) People who judge you for what you look like outside are not worth worrying about, nor are their opinions, so they are not worth the time being concerned over, you have enough on your plate without dealing with anyone else's shortcomings; (3) You are not who you are on the outside, you are who you are on the inside, a strong, brave individual who got through what sounds like tremendously horrific and physically taxing medical procedures along with the fears, and you survived.  You are a survivor, you should be proud, not scared now of people.  Look what you got through, do you really think that there's anything out there that you feel now that you can't get through?   I am so proud of your strength, you should be as well.  Cancer couldn't keep you down, don't let a fear of small people even waste a cell in your brain.  Be proud of who you are and what you can endure, because you have endured it, and people should be, as I am, in awe of you, because no one who has ever been through anything similar would judge you, it's only the superficial ones who have yet to have their time (and they will) when they face a life-changing event who would ever be so crass.  But in all cases, they are not relevant and should not stop you from living the life you fought to keep.  I am going to be bold and speak for those of us on this site who are aware of what you are going through and tell you that you have the support and love of all of us, and we've never seen the outside of you, we don't need to, because it does not matter.  You go live your life because you earned it.  Every minute you are afraid of someone else's opinion, you are losing and won't get back, so don't give anyone that power, you keep your power and you keep going and get out there and take stock and move on.  You are worth it!!!!!

Posted 2009-11-10T16:46:38Z
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