Road ahead

[Dawn Walsh]

We live in Utah, and I was just wondering if there were any other families here that are living with Oligodontia. My son is 6 years old and is missing 12 baby teeth and missing 24 adult teeth. He currently has a 'team' of doctors and has 2 sets of partials/ spacers since he has no front teeth at all. He is being monitored every 6 months for growth and I am told he has a long road ahead of him, including many surgeries and bone grafts, etc since he has little to no bone in the enter of the jaw bone - mid line degeneration they called it. We are fortunate, our medical insurance does cover the condition Oligodontia specifically. However, it is difficult to get the dental providers to code things properly in order to have the claims paid the first time. If any one has tips on that I would appreciate it.

Also, I keep hearing about genetic testing. I was wondering what specifically we would be looking for. Years ago when we spoke with a specialist, they ruled out Ectodermal Dysplasia, they said genetic testing wouldn't do us any good. They just said he had a dental anomaly. Is it worth genetic testing and for what reason. Thanks for listening.

Dawn Walsh

[trici...@cox.net]

If your insurance specifically covers  Oligodontia and there no signs of ED, then I would not pursue it. These kids don't need to spend more time in doctors offices. 

Regarding cross walking dental codes to medical, this is a HUGE problem for Oligodontia  cases. We've spent thousands of dollars with a consultant that promised the moon and delivered a lot less.  Be careful and if you do hire one, try to make payment based on results produced, not hours spent, like an attorney.  

We are currently In the appeals process with our insurance company.  Part of our appeal request is asking them to convert the codes for us.  They specifically agree to pay for genetic anomalies, which this is. So in good faith, they should assist in translating the codes. We will see how this goes. 

Btw, what insurance do you have that specifically pays for Oligodontia? 

Tricia Lamm

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[trici...@cox.net]

One of the things we can do, as a group, is share the cross walked codes on the numerous procedures. Not sure how to implement this, but it could help us all with getting reimbursed. 

Tricia Lamm

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[tricia]

Have you had any luck with getting you dental provider to code things in medical codes? We are having a lot of issues with this. Tricia Lamm 

[Dawn Walsh]

We are still working with insurance and the dental provider on getting the coverage. When I speak to the insurance they are cooperative and it seems good, but then I speak with the dental office and they say they are waiting for insurance. So, I'm not sure where the disconnect is. 

How old is your daughter Tricia? Where are you guys located? 

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[Patricia Lamm]

We are in Newport Beach. CA, which is in southern CA.  Our

Daughter is almost 17.  She had a palette expanded at age five, four sets of braces, periodontal surgery, double jaw surgery and innumerable prosthetic teeth before and after jaw surgery.  Currently getting veneers and new prosthetic bicuspids (8) which will include Maryland bridges to maintain spaces for 8'implants when she gets older. Medical insurance paid for jaw surgery and periodontal surgery. Dental insurance covered one set of braces. We've paid for the balance with the biggest part being the prosthetic teeth and veneers.  

Incidentally, we appealed medical insurance twice to get almost full coverage on jaw surgery and periodontal surgery. 

Tricia Lamm

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On May 27, 2015, at 8:05 AM, Dawn Walsh <dwalsh...@gmail.com> wrote:

We are still working with insurance and the dental provider on getting the coverage. When I speak to the insurance they are cooperative and it seems good, but then I speak with the dental office and they say they are waiting for insurance. So, I'm not sure where the disconnect is. 

How old is your daughter Tricia? Where are you guys located? 

On Fri, May 15, 2015 at 11:17 PM, tricia <trici...@cox.net> wrote:

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[Patricia Lamm]

Dawn, the dental office likely has no experience submitting to medical insurance. It's a completely different form and codes. You may have faster response getting reimbursed if you submit to insurance yourself directly.   Insurance won't except you to know codes etc. it will likely get sent back to you, but if your insurance covers Oligodontia, they have a legal obligation to help you. Ask for a Case Manager.  BTW, what insurance do you have? Great that they cover this. Any policy limits on it? Such an expensive thing to treat! 

Tricia Lamm

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On May 27, 2015, at 8:50 AM, Patricia Lamm <trici...@icloud.com> wrote:

We are in Newport Beach. CA, which is in southern CA.  Our

Daughter is almost 17.  She had a palette expanded at age five, four sets of braces, periodontal surgery, double jaw surgery and innumerable prosthetic teeth before and after jaw surgery.  Currently getting veneers and new prosthetic bicuspids (8) which will include Maryland bridges to maintain spaces for 8'implants when she gets older. Medical insurance paid for jaw surgery and periodontal surgery. Dental insurance covered one set of braces. We've paid for the balance with the biggest part being the prosthetic teeth and veneers.  

Incidentally, we appealed medical insurance twice to get almost full coverage on jaw surgery and periodontal surgery. 

Tricia Lamm

Sent from my iPhone

On May 27, 2015, at 8:05 AM, Dawn Walsh <dwalsh...@gmail.com> wrote:

We are still working with insurance and the dental provider on getting the coverage. When I speak to the insurance they are cooperative and it seems good, but then I speak with the dental office and they say they are waiting for insurance. So, I'm not sure where the disconnect is. 

How old is your daughter Tricia? Where are you guys located? 

On Fri, May 15, 2015 at 11:17 PM, tricia <trici...@cox.net> wrote:

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[Dawn Walsh]

That's a good idea, I had no idea I could try to submit myself. I feel like I am learning and teaching people along the way. I have Select Health, which is a local insurance here in the state of Utah. I am not aware of any policy limits. Thank you for the insight, my son is only 6 so this will be our reality for quite some time. 

[Brett and Heather Heyland]

Hi dawn
I just googled oligodontia Utah and this google group popped up with your post saying you live in Utah. I live in Utah too and we found out a couple of years ago that my daughter has 17 missing permanent teeth. You said you have a team of dr. I am wondering who you take your son to see. I would love to get a team of dr's and a plan of what the future holds for us.

[Dawn Walsh]

What area of Utah are you in? We have recently moved away but our doctors were all in the northern Utah (Ogden) area.

Dawn

On Thu, Apr 13, 2017 at 11:51 PM, Brett and Heather Heyland <heylan...@gmail.com> wrote:

Hi dawn
I just googled oligodontia Utah and this google group popped up with your post saying you live in Utah. I live in Utah too and we found out a couple of years ago that my daughter has 17 missing permanent teeth. You said you have a team of dr. I am wondering who you take your son to see. I would love to get a team of dr's and a plan of what the future holds for us.

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