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My wife has a condition that is covered by Medicare---GVHD,

Graft Versus Host Disease, which...
My wife has a condition that is covered by Medicare---GVHD, Graft Versus Host Disease, which she fought for 4 years with Prednisone. Prednisone kept GVHD in check and now her system is able to keep GHVD in check, for the past 14 months---she has been prednisone free. However, prednisone has side effects--it decreases the blood supply to the ends of the bones. Hence, she has had two joint replacements and needs two more! However, GVHD did do in her sliva glands before it was held in check, as I mentioned before. One of the spin offs of no sliva is very dry mouth. Hence, her medical condition has caused an increase in caries in her mouth. She brushes, flosses and swabs several times a day, but the bad germs are able to atttack the base of her teeth causing a deepening replacement of her crowns. How can I submit a claim for dental work caused by a medical situation that is covered by a Medicare?
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Answered in 1 day by:
11/10/2011
LADYLAWYER
LADYLAWYER, Lawyer
Category: Legal
Satisfied Customers: 6,536
Experience: Civil; Family; HOA; Landlord/Tenant; Real Estate; Probate; Insurance; Immigration; Wills & Trusts
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LADYLAWYER :

Hello, Thanks for choosing Justanswer.com! I look forward to helping you with legal information today.

LADYLAWYER :

It sounds like your wife may have Sjogren's Syndrome, which is an autoimmune condition that attacks the saliva glands and makes the mouth very dry. I would recommend she see a rheumatologist and be tested for all the Sjogren's antibodies. If she is diagnosed with Sjogren's Syndrome, Medicare will probably cover her dental work. You will need to find a dentist that bills Medicare.

LADYLAWYER :

Another option is to ask if Medicare has assigned your wife a Case Manager. They will tell you no, but ask for the Supervisor, etc. You can also ask for the phone number for the Case Management department and talk to them directly.

LADYLAWYER :

Medicare Does Cover These Types of Dental Services:

LADYLAWYER :

Dental services that are an integral part of a covered procedure (e.g., reconstruction of the jaw following accidental injury).

Extractions done in preparation for radiation treatment for neoplastic diseases involving the jaw.

Oral examinations, but not treatment, preceding kidney transplantation or heart valve replacement, under certain circumstances. Such examination would be covered under Part A if performed by a dentist on the hospital's staff or under Part B if performed by a physician. This is because the purpose of the examination is not for the care of the teeth or structures directly supporting the teeth. Rather, the examination is for the identification, prior to a complex surgical procedure, of existing medical problems where the increased possibility of infection would not only reduce the chances for successful surgery but would also expose the patient to additional risks in undergoing such surgery.

Hospital stays if needed for emergency or complicated dental procedures, even when the dental care itself is not covered. In these cases you should call your Part A contractor for more information.

Inpatient hospital services in connection with the provision of such dental services if the individual, because of his underlying medical condition and clinical status or because of the severity of the dental procedure, requires hospitalization in connection with the provision of such services.

Surgical procedures for the reconstruction of a ridge as the result of and at the same time as a tumor removal (for other than dental purposes).

Payment for the wiring of teeth when it is done in connection with the reduction of a jaw fracture.

Dental splints are covered if used in conjunction with the treatment of a covered medical condition (i.e., dislocated upper and/or lower joints).

Medicare makes payment for a covered dental procedure no matter where the service is performed. The hospitalization or non-hospitalization of a patient has no direct bearing on the coverage or exclusion of a given dental procedure.

LADYLAWYER :

The Medicare chronic disease dental scheme was introduced in November 2007. The scheme allows chronically ill people who are being managed by their GP under an Enhanced Primary Care (EPC) plan access to Medicare rebates for Dental services. So as long as your wife's need for the dental work is required because of a chronic condition (which it sounds like she already has), then she should be covered.

Customer:

Thanks for the info. It looks like I can submit bills for current work to Medicare. Is there a form to use or her dentist to use? Also, it looks like I should find the Medicare number and talk to a case worker or a supervisor for further clarity.

Customer:

Sorry I wasn't on the compurter earlier this morning as I was busy helping my wife in the home.

LADYLAWYER :

No problem! There is often a form that the dentists who ork with Medicare will have for to submit. Otherwise, you can ask the Case Manager to send you a form. Blessings to yoand your wife. I also have Sjogren's so I am in the same boat with the oral care.

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