I'm just a 52-year old youngster, but I'm hoping someone in these forums can help me out. My mother is 73, has multiple stents, on several medications, etc. She has been suffering from horrible dental pain and the dentist she works with finally said we have to remove some of the teeth due to infection. If I understand correctly, the infection started in the wisdom tooth and spread to multiple other teeth. She showed up at the dentists office to get the work done and due to her frail condition, he decided that they would have to do it at the hospital. The next day, she was called and told they couldn't do the work because, "it could leave her a mountain of debt." She's tried multiple other dentist, but can't find anyone willing to the work. Her primary care physician is now trying to get the infection under control with anti-biotics, but once that is done, there is still the main problem that needs to be dealt with. Does anyone have any advice or experience with this type of thing? Are there resources that we can bring to bare in order to get her dental health back in line? She isn't trying to get implants or something fancy. She has been suffering with these since before COVID shut everything down and now she just wants the teeth removed that are causing all of this suffering. Any advice, resources, etc will be greatly appreciated as I have no idea how to proceed.
I agree with somarco - your Mom is in a difficult situation if she is trying to get help paying for what is kind of outside the norm - meaning that she needs hospitalization for teeth extraction, if that be the case.
I agree with somarco - in addition to this procedure being difficult for your mom in her present health condition - it is all about the liability issues of the providers.
Personally, if I were in her shoes - her overall health condition as interpreted by a specialist - would be the 1st thing to find out. She may have to have approval by this health expert before any dental professional would be willing to perform the procedure - the specialist should be able to determine if she can have the extraction in the normal way or whether an in hospital extraction has to be done. There may be a happy medium - in an outpatient hospital setting.
Depending on what her medical specialist says she needs, she has dental insurance - that might be a better way to proceed than solely Medicare - but the best possible way would be to find an oral surgeon on her dental insurance list (if a network plan) that is also on the Medicare (take assignment) list. Medicare.gov - Lower costs with assignment -
Your Mom can also file her own claim with Medicare Part A if surgery is positively needed - they will reimburse her IF IT IS APPROVED so she has to have sound and irrefutable documentation.
Specifically what kind of insurance does she have? Medicare ? What kind? Medicare Advantage plan? Traditional Medicare? Does she have Medicaid too?
Medicare does not cover most dental procedures - extractions is one that isn't covered however if your Mom HAS to have it done in a hospital because it is MEDICALLY NECESSARY, Medicare Part A will pick up some of the cost but it has to be, in this case the where, not the what, MEDICALLY NECESSARY and the doctors (dental surgeon) has to go to bat for this, be in network or accept Medicare assignment, to save her money, and know the correct codes to bill Medicare.
She will still have to pay her part of the cost - her co-pays and the cost of the extractions.
If it is NOT medically necessary that she have it done in a hospital, then she will pay the whole cost to have it done - She may have to find an oral surgeon that will do it if there is any risk others may not be willing to take because of her medical condition.
What types of medical professional are making this call?
What's the call being made here for - her care or money - whose money - hers or theirs?
If I were your Mom, I would have a conversation with all the docs involved, get something in writing as to their recommendations and go from there. The primary would be the ones that are in charge of whatever medical condition that she has that is causing this second guessing and the type of professional that will be removing the teeth.
Don't forget that she has to eat afterwards so some type of prosthedontal work might be also necessary -
high option federal employees GEHA dental insurance
federal employees STANDARD Blue Cross Blue Shield as secondary
I'd love to help her out, but my mother is very independently minded and made it clear that she has this handled and doesn't want any assistance. She is going to contact Medicare and attempt to find a local oral surgeon that takes medicare, but when I searched on the medicare website, I couldn't find any Oral Surgery (Dentists), only 1 Oral Surgery, and 0 dentist within 50 miles. If she does come back and ask for assistance, I'd love to have any relevant information handy, so if you have any thoughts or experience with this, let me know.
@JefferyS501326 it is very hard to find dental providers who accept Medicare. That being said, I live in Atlanta, used the Medicare Physician Compare tool and found 56 providers that take assignment, all within 15 miles of my home. I filtered for "oral surgery".