Dental Insurance -- Questions to ask about losing teeth
March 18, 2021 10:20 AM Subscribe
My mother was diagnosed with oral cancer a few years ago and had to have 75% of her tongue removed. She also had to have oral radiation which is now ruining her jaw and teeth. She has already lost three teeth, and the others are not looking great. She is on Medicare but does not have dental insurance, and she is currently being quoted at $250K to remove her teeth and get dentures. I would like to be her advocate, but I don't know the right questions to ask.
When she has talked to her dentist, he has said that she needs to have 60 hyperbaric oxygen treatments in order to prepare and heal from any tooth extraction that would happen and that the tooth extraction costs between $2500-$5000 per tooth. Plus the dentures, the cost she's been estimated is almost a quarter of a million dollars. We (like many others in this predicament, I imagine) simply do not have this kind of money.
She has been trying to talk to Medicare on her own, but I think that they're being dismissive of her because her speech is impaired due to her tongue grafting, and I think that they're taking advantage of a woman with a disability. I would like to be her advocate, but I really don't know what the right questions are or where to start. Surely there are thousands of people who have had these similar oral cancer treatments and have lost their teeth due to radiation. What do they do?
Is it possible for her to get onto another insurance with this preexisting condition? Are there specific questions I should ask to Medicare to get information? Is there another workaround for her?
When she has talked to her dentist, he has said that she needs to have 60 hyperbaric oxygen treatments in order to prepare and heal from any tooth extraction that would happen and that the tooth extraction costs between $2500-$5000 per tooth. Plus the dentures, the cost she's been estimated is almost a quarter of a million dollars. We (like many others in this predicament, I imagine) simply do not have this kind of money.
She has been trying to talk to Medicare on her own, but I think that they're being dismissive of her because her speech is impaired due to her tongue grafting, and I think that they're taking advantage of a woman with a disability. I would like to be her advocate, but I really don't know what the right questions are or where to start. Surely there are thousands of people who have had these similar oral cancer treatments and have lost their teeth due to radiation. What do they do?
Is it possible for her to get onto another insurance with this preexisting condition? Are there specific questions I should ask to Medicare to get information? Is there another workaround for her?
That number is crazy. Another thing to think about are dental schools. It may not be a good fit with her other health concerns but something to consider. We have a good one in my state and I know folks who have gone there for tricky and expensive procedures for a fraction of the cost or free.
posted by pearlybob at 10:55 AM on March 18, 2021 [2 favorites]
posted by pearlybob at 10:55 AM on March 18, 2021 [2 favorites]
Also does her oncologist have a recommendation? They have presumably seen this before and ought to have recommendations for dentists who have had good outcomes in the past.
The $250,000 does seem really, really insane - I mean how many people are there who would be able to pay that much? How could that even be part of a dentist's business model? And dental insurance wouldn't make much difference, I have dental insurance but the maximum it will pay out in one year is like $2000.
posted by mskyle at 11:04 AM on March 18, 2021 [4 favorites]
The $250,000 does seem really, really insane - I mean how many people are there who would be able to pay that much? How could that even be part of a dentist's business model? And dental insurance wouldn't make much difference, I have dental insurance but the maximum it will pay out in one year is like $2000.
posted by mskyle at 11:04 AM on March 18, 2021 [4 favorites]
Response by poster: Thank you all for the quick replies! I don't want to thread-sit, but I do want to clarify a couple of things that folks have brought up.
I will say that since I haven't spoken to any of her healthcare representatives, it is definitely possible that she might be misunderstanding some of the aspects and costs of the procedure. All of your comps are giving me great estimates to use when I speak to them myself.
The complicated part sounds like because the risk of infection for her (because of her current jaw deterioration) is so great, they would need to extract her teeth in the hospital and potentially have her stay overnight. The hospital stay sounds like it is increasing the cost of the procedure.
posted by orangesky4 at 11:42 AM on March 18, 2021
I will say that since I haven't spoken to any of her healthcare representatives, it is definitely possible that she might be misunderstanding some of the aspects and costs of the procedure. All of your comps are giving me great estimates to use when I speak to them myself.
The complicated part sounds like because the risk of infection for her (because of her current jaw deterioration) is so great, they would need to extract her teeth in the hospital and potentially have her stay overnight. The hospital stay sounds like it is increasing the cost of the procedure.
posted by orangesky4 at 11:42 AM on March 18, 2021
It's interesting that her oncologist did not recommend extraction of her teeth prior to radiation. Irradiated bone runs a very high risk of not healing after extractions which is why oncologists typically refer for clearance prior to beginning radiation treatment.
I would not leave this case in any oral surgeon's hands unless they have experience dealing with post-radiation treated bone. Seek a referral from the radio-oncologist, they may have a network of oral surgeons versed in post-radiation extractions.
I'm going to guess she is having trouble with dry mouth, which will complicate whether she will ever be comfortable with a conventional denture.
Dental insurance is not the same as medical insurance. Pre-existing conditions aren't really a thing that disqualifies patients from being eligible, but some surgeries also qualify for medical coverage, so since the cancer therapy was what has created the need for treatment, it may be that the cancer treatment makes her eligible for coverage rather than the converse.
I'm not her dentist, of course.
posted by OHenryPacey at 11:45 AM on March 18, 2021 [12 favorites]
I would not leave this case in any oral surgeon's hands unless they have experience dealing with post-radiation treated bone. Seek a referral from the radio-oncologist, they may have a network of oral surgeons versed in post-radiation extractions.
I'm going to guess she is having trouble with dry mouth, which will complicate whether she will ever be comfortable with a conventional denture.
Dental insurance is not the same as medical insurance. Pre-existing conditions aren't really a thing that disqualifies patients from being eligible, but some surgeries also qualify for medical coverage, so since the cancer therapy was what has created the need for treatment, it may be that the cancer treatment makes her eligible for coverage rather than the converse.
I'm not her dentist, of course.
posted by OHenryPacey at 11:45 AM on March 18, 2021 [12 favorites]
Are you sure this kind of issue falls under dental insurance? I think you have a good case for this falling under the medical insurance since this occurred as a consequence of medical treatments. My experience is not exactly comparable, but my son had to have his "jaw broken" surgically to correct a severe dental problem, and the entire episode was paid for by our medical insurance. Part of this may have been because he was treated by an oral/maxilofacial surgeon, but I think this would bear closer questioning of the insurance. Perhaps a healthcare advocate might be of assistance in sorting this out? This seems like a very specific question that might need expert advocacy, as clearly this would be beyond the typical Medicare question a phone counselor might offer.
This really is much more than a mere dental issue, and there's a reasonable chance that there will be other issues that develop after radiation so severe it causes her to need teeth removal.
Excellent points by OHenryPacey above, who seems informed on these specific issues.
posted by citygirl at 11:53 AM on March 18, 2021 [4 favorites]
This really is much more than a mere dental issue, and there's a reasonable chance that there will be other issues that develop after radiation so severe it causes her to need teeth removal.
Excellent points by OHenryPacey above, who seems informed on these specific issues.
posted by citygirl at 11:53 AM on March 18, 2021 [4 favorites]
that is obscenely expensive. i can't speak to the other issues, but friend of mine have gotten teeth pulled for $250 a piece around here (still crazy expensive it seems to me). is it possible for you to go with her to appointments?
posted by misanthropicsarah at 12:29 PM on March 19, 2021
posted by misanthropicsarah at 12:29 PM on March 19, 2021
If that's genuinely the going rate for dental extractions where you are, look at another country. When the situation improves it may well be cheaper to fly overseas (i.e. Europe), have the surgery, heal, get the dentures fitted and fly home.
For comparison, I do not have any particular complications but I had a tricky rear molar removed earlier this week--privately, not NHS, and without insurance. It cost me UK£288 (US$400) all in.
posted by Hogshead at 12:19 PM on March 20, 2021
For comparison, I do not have any particular complications but I had a tricky rear molar removed earlier this week--privately, not NHS, and without insurance. It cost me UK£288 (US$400) all in.
posted by Hogshead at 12:19 PM on March 20, 2021
This thread is closed to new comments.
Also, see if she can qualify for Medicaid due to her disability and perhaps her income, because Medicaid includes dental insurance in some states. I work for someone who is fully disabled and using Medicaid dental to help with getting some tooth implants this year.
I would also contact the major private dental insurance companies and ask if they have plans you could buy that cover dentures - only some private dental insurances cover dentures and implants.
posted by zdravo at 10:46 AM on March 18, 2021 [4 favorites]