Medical Insurance Benefits for Dental Services

Medical insurance for dental procedure

Years after my treatment for oral cancer, I was losing teeth. They say, ‘radiation is a gift, but it keeps on giving.’ At first I had a Maryland bridge. That worked for a while until an adjacent molar had to be extracted. My dental oncologist, Dr. Devin Okay in NY, wanted me to consider dental implants. Even though several dentists told me about the high rate of osteoradionecrosis (death of jaw bone) is more common after radiation, Dr. Okay said the opposite. ‘If you don’t have dental implants, your bone will recede over time and you will have no future option for them.”

I made a few calls to my medical insurance company, but in the end, they said they would pay for dentures. Even though dental implants were recommended, the insurance company told me, “We will not pay for dental implants because they are cosmetic.”

I wish I thought of asking, ‘Do you pay for breast implants after breast cancer? Would that be considered cosmetic?’ I was losing weight unable to eat normally without molars!

Today, I met Laurie with Devdent, a company that helps educate practices on how they can maximize medical insurance benefits for patients who need dental services. Laurie Owens is the Director of Medical Billing Education and she told me she won cases similar to mine. (laurie@devdent.com, 855.534.1433)

Here is what she shared with me: “There are hidden wheels within medical that can be accessed that people do not know about: ‘Rare disease’ clause is one of them. What you went through, Eva, would have gone under that clause and your implants would have been covered. The hardest part is getting dental providers to write as if they are looking at the bone and the structure of the mandible and maxillary arches and omit saying, ‘we are replacing teeth.’ I have won cases on dental implants after treatment for oral cancer! Medical insurance is realizing the cost-saving opportunity versus the payout now.“

I wish I knew Laurie 10 years ago when I had my dental implants! Share your story about dealing with medical insurance for dental services. All I know is getting coverage for almost anything is getting harder and harder!

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