Wife needs Apicoectomy. Health insurance coverage?

Question

I asked twice before with long descriptions of the procedure. If you are familiar with this, my question is: Is it considered a medical necessity to have this done? My dental insurance only covers $1000 and the procedure is supposed to be $8000. She needs it done on the 6 upper front teeth. I am hoping that my health insurance plan will cover it. She has an active infection in the bone and I feel that it is medically necessary to have this done. What are your feelings on this? I am not interested in an answer from "Biologic Dental Consultant" thank you.

Answer 1

Thank you for saying that about the Bio Dental information they seem to be spreading all over here. As for your question it will need to be determined by the oral surgeon for it to be considered a medical problem and be submitted. In most cases such as your wife's, it is considered as such and the medical coverage picks it up. But I don't know the situation that has caused this and can't be positive, so you should rely on what the OS says.

I don't think obtaining additional insurance will help, as this will be considered a "pre-existing condition" and most all insurance co. have a clause that covers this and disallows any claims submitted. I would suggest just filing for a "pre-determination" (if there is time) to see what and if it's covered. The office manager or insurance clerk at either the dental or Oral Surgeons office will be able, and more than happy to help you with the needed forms and they will submit everything that is required for it to be processed quickly. You just need to relax and spend time and take care of your wife, who I'm sure is very anxious over both the procedure and the expense.

Answer 2

I might suggest you to visit this web page where onel can compare rates from the best companies: http://INSUREFOREVERYBODY.INFO/index.html?src=2YAsatvek5nE8

RE :Wife needs Apicoectomy. Health insurance coverage?
I asked twice before with long descriptions of the procedure. If you are familiar with this, my question is: Is it considered a medical necessity to have this done? My dental insurance only covers $1000 and the procedure is supposed to be $8000. She needs it done on the 6 upper front teeth. I am hoping that my health insurance plan will cover it. She has an active infection in the bone and I feel that it is medically necessary to have this done. What are your feelings on this? I am not interested in an answer from "Biologic Dental Consultant" thank you.
Follow 6 answers

Answer 3

I don't know what you got in the other Answers, but has anyone suggested checking with your Medical insurance carrier? As an example, I have an eye condition that is considered Medical. So when I go to my Eye Dr., I not only file with the eye coverage, I also file with my medical. Call your medical insurer, explain your situation...good luck to you and your wife

Answer 4

wife apicoectomy health insurance coverage

Answer 5

are these people wrong as well...

http://www.healthboards.com/ubb/Forum39/HTML/002224.html

ellie40
Junior Member

Posts: 9
From:wi,usa
Registered: Mar 2003
posted 08-20-2003 08:56 PM
--------------------------------------------------------------------------------
I am very upset, I had a root canal done a year ago. Had the root canal,then had it crowned and spent over $1200 out of pocket (after insurance covered it's share.) I am now experiencing pain and sensitivity to hot/cold in the tooth that was root canaled. I also have a small lump on the gum above the tooth. So I went back to my Dentist who did the root canal and she x-rayed the tooth and told me I need to be referred to an Endodontist. The Endodontist has now informed me that he needs to do an apicoectomy which is cutting into my gum so he can get at the infected tissue and remove the very end of the root. He said sometimes root canals need retreatment and that my bone near the gum line has infection surrounding it. Now this procedure is over $1000 and my portion after insurance will be $525 (which I have to pay half the day of service and the remaining balance within 3 months) I am still paying off the original root canal and crown!!! I am so upset because he mentioned that he gives the tooth a 70% chance of success. I asked him what next if it fails he said well then we pull the tooth and you will have to look into a bridge,etc. I dont know if I should spend anymore money for just one tooth especially when i could end up losing the tooth if this doesnt work! Has anyone had a similar experiance? I have such rotten luck-
IP: Logged

Deb47
Senior Member

Posts: 186
From:USA
Registered: Jun 2002
posted 08-20-2003 09:46 PM
--------------------------------------------------------------------------------
Hi, Ellie. I sure feel for you. I had the same thing happen to me, with a top right molar (second from the back). The sensitivity to hot/cold could mean that an extra canal was left in the tooth. I would ask the Endondtist if this might be the case. That's what happened to me, with my molar. The tooth hurt as much before the root canal, as afterwards. So I went to an Endondtist...he did a re-treat root canal; found an extra canal...but the tooth continued to hurt. Then I had an Apioectomy done; and it still hurt. I ended up pulling the tooth, after all that. That tooth also had been crowned (one dentist told me that crowning it might help calm it down: this was before the root canals: it didn't help). I ended up getting the tooth pulled, and a bridge made. This is all very expensive. I'm fortunate: I have this HMO type dental insurance. I only had to pay like $300.00 for the Apio; but I did pay $800.00 out of pocket for one root canal, and then I paid for the crown too. Then the bridge cost over $900.00. I don't know what to tell you. I do suspect they might have missed a canal: that's the only reason I know of, that the tooth would still be reacting to cold/hot. Maybe someone else will know more about it. Good luck to you; Deb
IP: Logged

taranino
Junior Member

Posts: 17
From:
Registered: May 2003
posted 08-21-2003 01:20 AM
--------------------------------------------------------------------------------
please, get it pulled! I did and I feels so much better now. It is so unhealthy to have a "dead" or rotted tooth in your mouth, even if they get most of the infection out some will always remain unless you pull the tooth...that's why root canals fail alot of the time.
IP: Logged

indy gal
Member

Posts: 37
From:
Registered: Jul 2003
posted 08-22-2003 12:01 AM
--------------------------------------------------------------------------------
I am in a very similar situation, except I had the apico done and I am now trying to decide whether to have the root canal retreated or not.
Here's my story in a nutshell:
March 02: Have root canal and tooth crowned
June 03: Discover abscess on root canalled tooth. Major pain, especially with heat.
July 03: Have apicoectomy done on tooth. Start recovering.
Aug 03: Begin having pain with hot foods/liquids again. Endodontist has offered to do a retreatment of the root canal for free (which he didn't do in the first place). That is scheduled for next week. But, in the meantime, the pain with heat has subsided, and leaves me wondering if I still want to go through with the retreatment.

If I don't do it and have problems a month later, I may not have the chance to have it done for free. But maybe the tooth is "healing", if that is at all possible. :-( I never knew a root canaled tooth could cause so much trouble.

I wish I could see into the future and know if this thing will ever get better on its own, or if it will only wind up flaring up again.

IP: Logged

Tascha
Junior Member

Posts: 19
From:T.O.
Registered: Aug 2003
posted 08-22-2003 11:29 PM
--------------------------------------------------------------------------------
I had a root canal, then a year later the tooth broke off at the gum line. I had to get what was left of it pulled out.
I think root canals are bull crap and I'm all for just pulling the tooth and ridding your body of the poison.
IP: Logged

butterflycollective
Junior Member

Posts: 6
From:u.s.a.
Registered: Aug 2003
posted 08-24-2003 04:44 PM
--------------------------------------------------------------------------------
I'd do what others here have said and ask if there's an extra canal. If there is, I'm not sure how an Apic would work, since that deals mostly with the bottom of the root. If you are going to have surgery, it should at least have a high probability of success. I don't know about percentages. My first root canal had a 95% chance of success but failed b/c of an extra canal(which means it had no chance of success, really). The retreatment had a 85-90% but actually was a more thoroughly done procedure than the first. I guess I'll have to see...the annual check up for it is coming up.
IP: Logged

butterflycollective
Junior Member

Posts: 6
From:u.s.a.
Registered: Aug 2003
posted 08-24-2003 04:51 PM
--------------------------------------------------------------------------------

Answer 6

I totally agree with HeatherS. That information about Bio Dental information is absolutely ridicious.

Answer 7

This has been answered many times before

Answer 8

Oh my!
OK....ummmm. Check out this site:
http://www.qualitymedicalcare.org
If you would like some personal assistance then please call me at 800-690-8101
This should help!
Good luck!

Answer 9

thanks! Very informative and it offers me better knowledge