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Insurance denial

hwt's picture
hwt
Posts: 1836
Joined: Jun 2012

I have BCBS insurance. Not old enough yet for medicare. Even though most of my lower teeth were extracted to remove my jaw (cancer of the mandible) they are denying a claim for implants to replace them. They are even denying a denture.   Wondering if anyone has had their medical insurance pay to replace the teeth taken as a result of cancer? BCBS says the code submitted doesn't qualify.

Skiffin16's picture
Skiffin16
Posts: 8058
Joined: Sep 2009

It seems that I remember a few on here that had insurance pay as the medical facility wrote it hope under a medical necessity or caused due to cancer and treament, which was covered undder the medical portions...

Someone will chime in I'm sure...

JG

lorig01
Posts: 66
Joined: Jul 2012

Hi.  I was in the same boat.  I eventually talked them in to paying for the removal of my teeth but they would not pay for dentures and/or implants.  I hope you have better luck than I did. Originally they refused to pay for the removal of my teeth but I fought them on that and they did pay.  I wish you luck.  I always found it aggravating that insurance would pay for breast implants/reconstruction after breast cancer but would not pay for dentures/implants after H&N cancer. Seems to me that teeth are more functional than breasts but I think a few might agure otherwise :). 

traceyd1
Posts: 25
Joined: Nov 2012

We are in the same boat.  My husband had his mandible removed  on the right side last year due to mandibular sarcoma.  BCBS initiallly told us that they wouldn't cover implants, then our employee benefits rep said that they would pay as long as the procedure was done in the hospital.  Of course, the case worker that got that info for us no longer works for BCBS, so now we we'll be back to square one!  We are hoping to start the implant process in August or September.  I'll post our dealings with insurance as they happen.  Good Luck!

Duggie88's picture
Duggie88
Posts: 526
Joined: Feb 2010

I am a trustee on a pension and health and welfare fund and my advise would be appeal the decision. I hear appeals every month and depending on individaul circumstances we overturn decisions in some instances. When you were denied they should have informed you in writing how to appeal.

      Jeff

debbiejeanne's picture
debbiejeanne
Posts: 2280
Joined: Jan 2010

Jeff, i've been wanting to ask this since the first time i saw your pic.  does your wife have a cigarette in her hand?  it sure looks good.  i smoked for 43 years and still miss it alot.  thanks to the cancer, i quit.  still wish i could smoke but refuse to since it can cause the cancer to recurr.  oh well, just thot i'd ask b/c it looks like she does.

God bless,

debbiejeanne

Duggie88's picture
Duggie88
Posts: 526
Joined: Feb 2010

Yes Debbiejeanne she does. After all I went through and her with caring for my sorry a.. she still smokes. She has cut down but even 1 is too many. Every now and then I will ask her for one just to get a reaction. Everytime I post something I look at the picture and see that hanging from her right hand and think WOW it's only a matter of time until someone notices.

By the way I think it was John who said he will pay for a family of six at the Red Lobster for the first one to notice the cig. Thats right I think the deadline for that was yesterday April 1st.

Skiffin16's picture
Skiffin16
Posts: 8058
Joined: Sep 2009

Yep, deadline is over... Shells and I just used the gift card...Cool

debbiejeanne's picture
debbiejeanne
Posts: 2280
Joined: Jan 2010

out of time, just my luck.  i'll meet the deadline next time john...lol.  i hope ur wife can quit smoking.  did u used to smoke?  if so, do u miss it like i do?  when my cancer came back, i was still smoking and i had to have a complete laryengectomy.  now i miss the ability to talk.  i never realized how important being able to talk was.  oh well, enuf of that.  thanks for replying.  hey, john, i noticed the cig b4 2day, it just took me until 2day 2 get the nerve to ask....lol.

God bless,

debbiejeanne

Skiffin16's picture
Skiffin16
Posts: 8058
Joined: Sep 2009

Well..., you might have to come to central florida to collect, LOL...

As for cigs..., neither be nor my wife have ever smoked... (well I might have blew a few ummm twisty cigs back in the day, or maybe quite a few)... But that was in a galaxy far far away...

JG

Duggie88's picture
Duggie88
Posts: 526
Joined: Feb 2010

I was a truck driver for years before I was elected to union office and most days smoked two packs a day. I quit January 22, 2000 and was diagnosed with throat cancer November 22, 2009. I don't miss it at all. I do miss John's twisty ones because that is when I came up with some of my best ideas.

 

George_Baltimore's picture
George_Baltimore
Posts: 303
Joined: Jun 2009

John was a bit twisty!

hwt's picture
hwt
Posts: 1836
Joined: Jun 2012

It is encouraging to know it's not a closed door and that real people are involved. Thanks!

 

katenorwood
Posts: 1808
Joined: May 2012

hwt,

My insurance carrier only paid for the extractions due to medical necessity.  But the dentures were all out of pocket.  I think this is nuts period !  We didn't ask for this it was an absolute we had it done.  Appealing their decission may work, I wish you all the best with this.   Katie

denistd's picture
denistd
Posts: 488
Joined: Apr 2009

I did manage to get the insurance company to pay for the extractions but had to pay myself for the dentures, I wrote to them asking how to appeal and they said that was not a covered item and there is no reason to appeal, period.

 

tommyodavey's picture
tommyodavey
Posts: 352
Joined: Nov 2011

I too have BCBS.  When all of my treatments were going on I thought about whether my insurance would cover any dental benefit.  My plan only has a small dental plan for checkups and xrays only.  So I called them.  The woman who I spoke with said yes, any dental issues related to your cancer will be covered.  Problem is I don't have the information sheet she was reading from.  My plan brochure doesn't show what she was reading.  So after the phone call I forgot about it until you posted this question.  Now I wonder if they will cover it all or only a few procedures.

 

Time will tell eventually.  And yes, go for that appeal!

 

Tom

hwt's picture
hwt
Posts: 1836
Joined: Jun 2012

Appreciate everyone's replies. Apparently, when it comes to insurance allot has to do with coding. I understand that implants are virtually never covered but not to cover dentures when they removed the teeth is unthinkable. I paid for my temporary dentures out-of-pocket just because we didn't think they would pay for 2 sets. I had to have temps because I still have some teeth on the bottom to be extracted and they ended up in front of my upper teeth. I also paid out-of-pocket for braces on those teeth to close the gap so I could eat. What a mess! It is nice to know that real people look at and consider the appeals. 

I recently had a kidney stone removed and just 3-4 hours as out-patient, the hospital charged $7,000+. I asked BCBS, if I paid for the implants, do they cover the hospital and they said only if he does something else covered. This was going to be a 2 part process and the 2nd part involved thinning some tissue, so maybe that can be combined to save me hospital expense.  The doctor said he would give me half off the implants if insurance didn't pay but that is still a hefty amount. 

I will also check with Human Resources from my husband's former employer. I've cancelled the surgery for the 17th and will reschedule after I've exhausted all avenues. I REALLY appreciate everyone's input. Thank You!

George_Baltimore's picture
George_Baltimore
Posts: 303
Joined: Jun 2009

I don't know of any insurance company that pays for dentures or implants.  At the time of my treatments in 2004, I had BCBS as the only insurance.  I had no problems at all with them paying for the extraction of 16 teeth.

hwt's picture
hwt
Posts: 1836
Joined: Jun 2012

Thanks George. Thought of you yesterday as I hadn't seen any recent posts. Glad to hear from you!

George_Baltimore's picture
George_Baltimore
Posts: 303
Joined: Jun 2009

just not as high as before!  :-)

Skiffin16's picture
Skiffin16
Posts: 8058
Joined: Sep 2009

Well that might be a good thing...if you tend to wear a kilt...

JG

George_Baltimore's picture
George_Baltimore
Posts: 303
Joined: Jun 2009

that I was leaving myself wide open to John, LOL.  After going to an orthopedic surgeon yesterday, I may have to start wearing a kilt since I will have a cast on my right leg for four weeks.  First one I've ever had in my life (I'm getting to old for this).  Once again, radiation has reached it's long tentacles out and slapped me in the face.  In June of 2011, when I had my mandible surgery, they removed my right fibula.  About 8 months ago, my big toe and the one next to it started curling under.  I finally got around to making an orthopedic appointment when it became more difficult to walk without pain.  He said when they took the fibula, they didn't worry about the rest of the mechanisms down there.  The tendons on the two toes need snipped and the achilles tendon needs snipped and lengthened.  $&%*-#!?$&% radiation!!!

hwt's picture
hwt
Posts: 1836
Joined: Jun 2012

I don't like to hear that. Best wishes for an easy and successful go of it. 

George_Baltimore's picture
George_Baltimore
Posts: 303
Joined: Jun 2009

I'm starting to get used to all these roadblocks being thrown up.

SueBinBend
Posts: 6
Joined: Jul 2012

back in 1996 when my mom had her first go around with throat cancer I got her insurance to pay for her dentures and her extractions. They denied it at first, and we appealed. You can always appeal.

Good luck.

 

hwt's picture
hwt
Posts: 1836
Joined: Jun 2012

Thanks...we have postponed my surgery until we have exhausted other avenues at the recommendation of my doctor. 

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