Insurance ?

[Gloria H]

Can anyone address the issue of insurance coverage? We have an 18 year old son who is missing eight permanent teeth. I have seen some scary numbers when looking at various "price per implant" numbers. We have limited dental insurance. Is Oliogodontia ever covered by major medical insurance? It seems this should be more than just a cosmetic/aesthetic issue. Any input is welcome. We have a great University dental program within 120 miles. Has anyone else gone this route? Can that be less expensive than a private practice?

The thought of trying to replace 8 teeth at $3,000 (at least) per tooth s nauseating!

Any input is appreciated!

Gloria

[Grace Lewis]

Gloria,

I haven't gotten that far yet. My son is 7 and he only has 5 permanent teeth. I think someone said in New York there was a law passed that oligodontia had to be covered by health insurance but I think in most states there is no law and it would just involve you presenting your case to your insurance company. Let me know what you find out!

Grace

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[Gloria]

Thank you Grace. I will be checking with BCBS. I believe there is wording in there regarding "congenital defects". We've met our deductible and then our policy pays at 100%...so great time to try to make it happen!

I will let you know what I find out.

Gloria

Sent from my U.S. Cellular® smartphone

[Susan S]

Insurance coverage is dependent upon where you live. Yes, medically this is a congenital defect. This is not a dental condition. However, it is dependent upon each state. There is an insurance regulation in New York that specifically states congenital defects. You must check with where you live, and the insurance companies often offer little help. You have to get written medical support to get your medical insurance to cover this even with the regulations. I have letters from my dentist, orthodontist, and medical proof that this is genetic. Even with all of this it is very hard to connect with the correct insurance personnel that can understand that this is not a dental condition. I was able to get some of my daughter's work covered, but seriously it took hundreds of hours fighting for what is legally covered. You must be a determined, strong individual who will insist upon advocating for your child. I am currently in the midst of this process again for my middle son. I have worked tirelessly all summer and still have not gotten anywhere.

[Tricia Lamm]

Susan,

What exactly was your "medical proof" that this is a genetic condition? Was it genetic testing results? Thanks, Tricia Lamm

On Aug 25, 2013, at 8:16 AM, Susan S wrote:

> Insurance coverage is dependent upon where you live. Yes, medically this is a congenital defect. This is not a dental condition. However, it is dependent upon each state. There is an insurance regulation in New York that specifically states congenital defects. You must check with where you live, and the insurance companies often offer little help. You have to get written medical support to get your medical insurance to cover this even with the regulations. I have letters from my dentist, orthodontist, and medical proof that this is genetic. Even with all of this it is very hard to connect with the correct insurance personnel that can understand that this is not a dental condition. I was able to get some of my daughter's work covered, but seriously it took hundreds of hours fighting for what is legally covered. You must be a determined, strong individual who will insist upon advocating for your child. I am currently in the midst of this process again for my middle son. I have worked tirelessly all summer and still have not gotten anywhere.
>

[Susan S]

Genetic testing can help, but I don' t know that it is required. Our dentist, orthodontist, prosthodontist, and surgeon each wrote a letter documenting what was needed and why it was medically necessary.

[Tricia Lamm]

Thanks, Susan. My surgeon, one of the best in the country, is quoting $59K for bilateral jaw surgery. But first, she will need a third phase of ortho, followed by $12K in gum surgery. Then, later when she is older, eight dental implants. It is just crazy expensive! Living in Southern California doesn't help either!

Tricia

On Aug 26, 2013, at 3:39 PM, Susan S wrote:

> Genetic testing can help, but I don' t know that it is required. Our dentist, orthodontist, prosthodontist, and surgeon each wrote a letter documenting what was needed and why it was medically necessary.
>

[Susan S]

Yes, the work is quite expensive and in-line with the NY fees I have seen charged for the same work completed on my older children. My younger daughter is going to need a lot more work due to the fact that she has only 14 teeth with no bottom molars.

[Dean McNeel]

Gloria

I am the parent of a special needs child and I am a prosthodontist, very sensitive to this issue of congenitally missing teeth. My wife has been preparing for one of her upcoming lectures when she pointed me to this group to see if I might be able to help answer a few questions. I have been treating patients with oligodontia and other congenital defects (children and adults) for 20 years with great success and we have learned a thing or two about medical billing. I have seen some of the costs discussed in this group for surgery and implants, both of which can be very expensive. But orthodontics, periodontics for gum tissue grafting and finally the restorations all can be equally expensive. No matter how skilled each doctor involved is they must know how to bill dental procedures under medical insurance, most don't have a clue. Many doctors feel they can write letters then stomp their feet and then get paid. NOT TRUE!!!!

We live in Arkansas, near the home of Walmart. And because Walmart requires that ANY company that sales to them have an office in Northwest Arkansas we see medical insurances from nearly every state. We have had great success billing these procedures to medical insurance and getting paid, because three years ago we attended the right medical billing course. This really does give families hope. We now field questions from doctors weekly from across the country on medically billing for dental procedures, I would be happy to share that course info with any of your doctors (Dr Z at the ZGroup). My wife, Lori, is also lecturing in 3 different states this month to dentist who want to learn how they can bill medically. It can be frustrating for a dentist to bill medically if they haven't been trained to do so. The insurance company certainly will not hold your hand and give you the proper medical codes. I would not be surprised to see an entire treatment go beyond $150,000 over the course of several years of treatment depending on which procedures are done. And yes, I do feel most of this can successfully be paid by medical insurance.

If you do not have medical insurance then maybe the dental school is a more economical option. There you may have to see a number of residents in training, but still a good option for those without insurance. I am unfamiliar right now with any government grants but you can look at the National Foundation for Ectodermal Dysplasias website for more help.

http://nfed.org/index.php/about_ed/types_of_ectodermal_dysplasias 

[Tricia Lamm]

Thank you so much for that encouraging news on medical billing, Dr. Z. Can you kindly provide complete contact information so that I can email you? My daughter will undergo a 12K periodontal micro surgery in a few months and then a 59K double jaw surgery next summer by the Arnett/Gunson group in Santa Barbara. I am going to deplete her college funds if I can't get some assistance. Thank you so much! It is very kind of you to offer  your assistance. My email is trici...@cox.net.

Tricia Lamm

Sent from my iPhone

On Sep 5, 2013, at 3:49 PM, Dean McNeel <mcn...@ozarkpros.com> wrote:

Gloria

I am the parent of a special needs child and I am a prosthodontist, very sensitive to this issue of congenitally missing teeth. My wife has been preparing for one of her upcoming lectures when she pointed me to this group to see if I might be able to help answer a few questions. I have been treating patients with oligodontia and other congenital defects (children and adults) for 20 years with great success and we have learned a thing or two about medical billing. I have seen some of the costs discussed in this group for surgery and implants, both of which can be very expensive. But orthodontics, periodontics for gum tissue grafting and finally the restorations all can be equally expensive. No matter how skilled each doctor involved is they must know how to bill dental procedures under medical insurance, most don't have a clue. Many doctors feel they can write letters then stomp their feet and then get paid. NOT TRUE!!!!

We live in Arkansas, near the home of Walmart. And because Walmart requires that ANY company that sales to them have an office in Northwest Arkansas we see medical insurances from nearly every state. We have had great success billing these procedures to medical insurance and getting paid, because three years ago we attended the right medical billing course. This really does give families hope. We now field questions from doctors weekly from across the country on medically billing for dental procedures, I would be happy to share that course info with any of your doctors (Dr Z at the ZGroup). My wife, Lori, is also lecturing in 3 different states this month to dentist who want to learn how they can bill medically. It can be frustrating for a dentist to bill medically if they haven't been trained to do so. The insurance company certainly will not hold your hand and give you the proper medical codes. I would not be surprised to see an entire treatment go beyond $150,000 over the course of several years of treatment depending on which procedures are done. And yes, I do feel most of this can successfully be paid by medical insurance.

If you do not have medical insurance then maybe the dental school is a more economical option. There you may have to see a number of residents in training, but still a good option for those without insurance. I am unfamiliar right now with any government grants but you can look at the National Foundation for Ectodermal Dysplasias website for more help.

http://nfed.org/index.php/about_ed/types_of_ectodermal_dysplasias 

On Saturday, August 24, 2013 12:08:53 AM UTC-5, Gloria H wrote:

--

[Dean McNeel]

Tricia

You are more than welcome. My wife and I are passionate about this. Lori is lecturing for Dr. Z, but all roads lead to Dr. Z as far as the ultimate training of medical billing to the doctors. I have cc'd Lori on this, she can email you contact info to give to your doctors about Dr. Z. I do know that she puts on training courses at Glidewell Dental Lab in California. I can't stress enough that this is you being your child's advocate, teach those doctors to help you. Do not deplete the college fund.  Or you can call Lori at our office tomorrow 479-582-3360. 

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[Dean McNeel]

Grace

Of course there is hope. I do not want you to sacrifice the college savings. The reference I gave earlier to the Ectodermal Dysplasia site shows over 100 types of Ectodermal Dysplasia. This really means that doctors can't even keep up with so many types. No wonder your doctors are skeptical. Please pay attention to the info that site is giving. They are your advocate and you are your child's advocate.

Please know that you can put the petal to the metal and see us in Fayetteville. We want to help. Or just call Lori for info at 479-582-3360.
And by the way we start various forms of treatment as early as 7 years old. I'm the quarterback leading the team toward the goal, which is healthy teeth for life.

Dean 
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On Sep 5, 2013, at 6:13 PM, Grace Lewis <graci...@gmail.com> wrote:

Dr McNell,

My name is Grace Lewis, my son Henry only has 5 permanent teeth. He is also missing some of his baby teeth. We took him to Childrens hospital to be tested for ectodermal dysplasia but the Doctor said he didn't have any other symptoms of ED and didn't recommend testing him.

 I live in Central Arkansas, my son is currently seeing Dr Hopkins an orthodontist in Searcy and Dr Wyatt our dentist, both have said nothing can be done until he is 17 and then he will need implants. 

Is there anything else you would suggest I do? I just don't want to get down the road and be told I should have done something different.  I appreciate you posting to this group so much! You have given me hope because everyone I have seen so far has told me forget saving for college and start saving for his teeth. I am a nurse and have good medical insurance. So I pray that it will cover some of the cost.

Thanks,

Grace

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[Tricia Lamm]

I just cannot express how thankful I am for this information. My husband, who sells heart devices, insisted that its all about the coding. I hope you both right. 

Tricia Lamm 

On Sep 5, 2013, at 5:01 PM, Dean McNeel wrote:

Tricia

You are more than welcome. My wife and I are passionate about this. Lori is lecturing for Dr. Z, but all roads lead to Dr. Z as far as the ultimate training of medical billing to the doctors. I have cc'd Lori on this, she can email you contact info to give to your doctors about Dr. Z. I do know that she puts on training courses at Glidewell Dental Lab in California. I can't stress enough that this is you being your child's advocate, teach those doctors to help you. Do not deplete the college fund.  Or you can call Lori at our office tomorrow 479-582-3360. 

Sent from my iPhone

On Sep 5, 2013, at 6:07 PM, Tricia Lamm <trici...@cox.net> wrote:

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[Tricia Lamm]

Along the lines of early treatment, Brittany got an palette expander at five years old. 

Tricia 

On Sep 5, 2013, at 5:26 PM, Grace Lewis wrote:

Wonderful!! I will call tomorrow to make an appointment! I'm so glad you emailed. You are an answer to my prayers!!

Thanks,

Grace

[Dean McNeel]

Then kiss your your husband. We'll have to verify this for you with your insurance, but there should be good news.

Dean

Sent from my iPhone

[Liza Katz]

Hi everyone, 

My 10 year old daughter is congenitally missing 14 of her permanent teeth but has all of her baby teeth. I am in the process of making appointments with local prosthodontists and orthodontists to begin treatment. I have been working with a very small group of parents here in MA to pass medical bills that would mandate the coverage of cranio-facial abnormalities by medical insurance. The bill we are working on was originally merged with a bill to cover cleft-lip and palate but was separated and the cleft-lip portion has since been passed. We are now working on passing this broader bill which would include ED and other cranio-facial abnormalities. 

I am curious to hear about the bill in NY that covers these disorders. Can anyone here point me towards that bill # so I can look up the language?

Dr. McNeel, I am also curious about this medical billing piece and would like to become more informed before we truly embark on the long treatment road. Is there anything I can do or bring to these initial appointments with orthos and prosthodontists that can get us started on the right billing foot? 

Thanks to everyone for sharing! 

~Liza

[Michelle Ball]

Hi Dr. McNeel,

My 18 year old daughter only has 8 adult teeth. The ones she has are small and misshapen.  I have fought with my insurance provider, who insists that getting implants is considered is a dental, cosmetic procedure because she still has most of her baby teeth.  My insurance company covers traumatic injury when teeth are knocked out, but not when teeth are missing.  We put veneer jackets on her front 8 teeth to make them normal adult sized and that was around 5K.  I am scared about trying to get her implants because of the high costs and though we make a decent living, we can't afford to get implants for approximately 28 teeth.   I have heard quotes from $1500-$3000 a tooth.  Her baby teeth still have good roots on them, but I don't want her to deal with this her entire life.  Can you please email me to figure out how to approach this with our implant doctor?  I live in Raleigh NC.  We go to Dental Arts with Dr.  I would be forever grateful for any help.  I have had sleepless nights thinking what I could sell or how much we could finance to get this all taken care of.  It causes a feeling of hopelessness.  My daughter loves her veneer jackets we got 2 years ago, but we were told they will only last about 10 years.  I really need information on how to bill dental procedures as medical conditions....esp. implantation of the titanium piece in her jaw and the tooth that snaps into it.  My email address is michellel...@yahoo.com.  Thank you in advance.  I am trying not to get too hopeful because I just feel the insurance companies are going to turn me down again.  Our doctor is Tarun Argarwal, his email is www.dentalartsraleigh.com, his phone number is 919-870-7645.  Their procedure coordinator who works with the insurance companies is named Melinda.  She tries to be helpful, but maybe she just doesn't have the knowledge in how to bill this correctly.  I SO APPRECIATE your email.  I look forward to hearing from you!

Warm regards,

Michelle

[Kenneth C. Laprade]

My 18-year-old son has 16 adult teeth (not counting wisdom teeth) and 10 remaining deciduous teeth.  We live in Florida, but he goes to school in California. He is currently undergoing orthodontia to prepare space for implants in about two years.  The dentists' plan starts with only a few implants, preserving the baby teeth as long as possible.  Perhaps he can keep them until he is 30, gradually getting implants as the baby teeth wear out.  By then it will be his financial burden...

The orthodontia is covered (to a limited amount) under our dental insurance.  Implants are not.  Our medical insurance plan is pretty clear about these type of situations: treatment for congenital dental defects is covered until eight years old.  Well, one does not get implants at eight years old, so that clause was no use to us!

I wish you luck in finding a treatment plan you can afford.

 - Ken Laprade

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[Ray Brown]

I saw this post. I am an adult male who has oligodontia. I had a lower and upper bridge anchored by my few adult teeth build 30 years ago. It is in dire need of replacement. Will you arm me with your billing information I can provide my doctors so I can embark in this project. I live in New York City which other posts indicate is a state obligated by law to provide for this service. My insurance is Aetna.

Thanks,

RAB

On Thursday, September 5, 2013 6:49:25 PM UTC-4, Dean McNeel wrote:

[Dean McNeel]

Ray

You are very lucky, we have a good friend in New York that is an expert in billing medical insurance for dental problems. His name is Dr. Pascal Malpeso, his phone number is 212-838-0090. Located 563 Park Avenue.

Good Luck!

Dean McNeel DDS

3394 Futrall Dr. Ste. 2

Fayetteville AR 72703

Office: 479-582-3360

Fax: 479-582-3466

Cell: 479-601-5498

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[Ray Brown]

Thanks,

I will give him a call.

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[Patricia Lamm]

Gloria, We have BCBS too and it says it too has wording regarding "congenital defects." What, if any, has BCBS reimbursed you? We've had some reimbursement for jaw surgery but none for prosthetics, periodontal surgery, braces etc.

 

Just curious if you've had any luck with them. We are currently in the appeal process with them.

 

Tricia

 
On Saturday, August 24, 2013 at 11:38:22 AM UTC-7, Gloria Ho wrote:

Thank you Grace. I will be checking with BCBS. I believe there is wording in there regarding "congenital defects". We've met our deductible and then our policy pays at 100%...so great time to try to make it happen!

I will let you know what I find out.

Gloria

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Grace Lewis <graci...@gmail.com> wrote:

Gloria,

I haven't gotten that far yet. My son is 7 and he only has 5 permanent teeth. I think someone said in New York there was a law passed that oligodontia had to be covered by health insurance but I think in most states there is no law and it would just involve you presenting your case to your insurance company. Let me know what you find out!

Grace

On Aug 24, 2013, at 12:08 AM, Gloria H <glogar...@gmail.com> wrote:

> Can anyone address the issue of insurance coverage? We have an 18 year old son who is missing eight permanent teeth. I have seen some scary numbers when looking at various "price per implant" numbers. We have limited dental insurance. Is Oliogodontia ever covered by major medical insurance? It seems this should be more than just a cosmetic/aesthetic issue. Any input is welcome. We have a great University dental program within 120 miles. Has anyone else gone this route? Can that be less expensive than a private practice?
>
> The thought of trying to replace 8 teeth at $3,000 (at least) per tooth s nauseating!
>
> Any input is appreciated!
>
> Gloria
>
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[waters...@optonline.net]

I am just joining this site.  I have oligodontia and am in the process of preparing an appeal for treatment with my medical insurance company.  I live in NY.  Are the phone numbers for Lori and Dr. Pascal still good ones to call regarding ICD 10 codes?  I am so grateful to you all for this information.  My work was completed 41 years ago and my current estimate is to large to type.  Thank you!  Susan