I don't post often on here but I was hoping there might be someone in the medical insurance field that may be able to help. I would like to try and have my medical insurance cover some extensive dental work. Why do I think they should?

 

Growing up I had near perfect teeth, no braces, good bite, only 1 cavity. Then life through me a curveball. I was diagnosed with cancer and would go on to relapse and then develop a different cancer- 3 diagnoses in 5 years. The chemo obviously takes a large toll on the body as the effects are most likely lifelong. I will most likely continue to develop more issues as I get older but that's the tradeoff.

 

Those perfect teeth, not so perfect anymore. Chemo and the immunosuppression destroyed my mouth. I couldn't properly care for my teeth and gums teeth for 3 months due to risk of infection. Ive had 6 teeth extracted, 4 that have just cracked and broke off due to the deterioration. And of course there's more that are right on their way to crack or break. Eventually my teeth will be infected most likely. Can't go through life with just gums and some broken off teeth.

 

I'll need dental implants and they do not come cheap. I've read $3K-$5K per tooth. Also saw another approach rather than implants, All on Four implants that run $25K-$45K.

 

You guessed it, no way I can afford that. So I want to try and have my medical insurance cover the extensive work but I'm not sure how I would do that. What I will need to submit this claim to medical insurance?

 

Any advice is appreciated! Thank you!!

From my experience with commercial insurance plans will usually cover Wisdom tooth removal or tooth issues due to accidental injury. I would reach out to your carrier and check with them directly. It's possible they can review medical dictation for approval but most plans have limitations and insurance companies usually won't make any exceptions to their plans. I wish you the best.

Not an expert, but if your dental problems are directly related to a medical problem, you should have a good case. Sounds like this is the issue. This I do know, do not take a rejection from your medical insurance as the final word. Keep fighting. It will be worth it in the end. Good luck.

You will need to get a dentist to provide you with a "pre-work up" on the implants that need to be done. This would need to be submitted to both your dental carrier and medical carrier. The dental carrier will estimate what, up to the maximums of the policy, they would pay for these services. Your medical carrier will typically deny these services, saying it is outside the scope of the contract. You will need to file an appeal. In this appeal, it is most important to have your oncologist or another medical doctor familiar with the effect your cancer had on your mouth, indicate in the appeal as to why this is a valid medical claim. Also, your dentist should indicate in the appeal the importance of your dental health moving forward. Be patient...stay the course, and I think good things could come.

I just wanted to say thanks to all of your for your advice! I'll let you know how things go!