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Medical Forum / General / Dentistry / October 2005Dentogenesis Imperfecta--medical insurance?
My wife has the rare condition called Dentogenesis Imperfecta. She had all of her teeth capped by a budget dentist in Mexico when she was younger. The dentist did an ok job I suppose, but certainly not top of the line. She is currently having all her teeth redone and the bill is WAY over what my dental insurance will cover. As part of the process, this week she saw an Endodontist for some root canals and he said we might try getting my medical insurance to pick up the bill because this is a genetic condition. If I recall correctly, my wife said the endodontist had a case where somebodies medical insurance paid for a genetic tooth problem of some kind, because it was genetic. I have not yet spoken with the dentist who is doing the bulk of the work for us about this, but I thought I would ask here and see what kind of info/suggestions somebody might have for me. Any tips appreciated. Thanks, --Dan It really depend heavily on what the plan actually says. Some have very specific language regarding dental care, usually something about accident related care, and sometimes more...but you have to dig thru the plan itself and find out. T > My wife has the rare condition called Dentogenesis Imperfecta. She had all > of her teeth capped by a budget dentist in Mexico when she was younger. The [quoted text clipped - 13 lines] > Thanks, > --Dan The one I love is ....... "least expensive alternative clause" .... buried somewhere in the contract. It means that a small space on the contralateral side means you cannot get the fixed bridge (they promised you when selling the policy). Instead you get reimbursed as if it were some crummy removable and very useless appliance! Joel >It really depend heavily on what the plan actually says. Some have very specific >language regarding dental care, usually something about accident related care, [quoted text clipped - 19 lines] >> Thanks, >> --Dan  SignatureJoel M. Eichen, . Philadelphia PA DISCLAIMER FOLLOWS: ********* Dental health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the SciMedDentistry gang or any other official agency either actual or fictitious or Steve Mancuso. Advice on the treatment or care of an individual patient should be obtained through consultation with a dentist who has examined that patient or is familiar with that patient's dental history. STANDARD DISCLAIMER >My wife has the rare condition called Dentogenesis Imperfecta. She had all >of her teeth capped by a budget dentist in Mexico when she was younger. The [quoted text clipped - 13 lines] >Thanks, >--Dan This is an interesting case Mr. Dan. Confirmation of the diagnosis of Dentogenesis Imperfecta would be the first order of business. Is there a genetic test for confirmation of this disease ? Anyone ? Note that it is very rare and research may be scant. Alright docs, let's step up to the plate. WB -- Take out the G'RBAGE to reply wubbabubbazG@RBAGEyahoo.com > >My wife has the rare condition called Dentogenesis Imperfecta. She had all > >of her teeth capped by a budget dentist in Mexico when she was younger. The [quoted text clipped - 24 lines] > > WB Don't know if there's a genetic test yet, but the signs are pretty characteristic, so it should be fairly easy to diagnose. According to my old Shafer, Hine, and Levy, it is inherited as an autosomal dominant trait, and often associated with osteogenesis imperfecta. The insurance issues are another thing. I suspect the provisions of the individual plan are critical, as Tony said. I suspect that state insurance law may also vary with respect to this. For example, in NY State, any dental care necessitated by an accident is automatically transferred to major medical, unless a motor vehicle is involved. I have heard of conditions (such as mandibular prognathism) where dental and medical insurance both deny benefits for correction, based on "no medical need", which is obviously patently absurd. Since the functional ramifications of osteogenesis imperfecta are so severe, I'd guess that getting coverage for dental problems may be easier where both conditions are present. This may be a situation where an insurance advocate may be advisable. Steve > -- > Take out the G'RBAGE to reply > wubbabubbazG@RBAGEyahoo.com -- Mark & Steven Bornfeld DDS Brooklyn, NY 718-258-5001 http://www.dentaltwins.com >> >My wife has the rare condition called Dentogenesis Imperfecta. She had all >> >of her teeth capped by a budget dentist in Mexico when she was younger. The [quoted text clipped - 42 lines] > >Steve Indeed. The Ins. co. may also deem this a 'pre-existing' condition and refuse payment for dental reconstruction. I suppose that the ability to eat may constitute a medical need since nutrition is an important building block in overall health. Will have to break out the ole SHL on monday ;-) I suspect that since there are pathognomonic signs and symptoms a clinical diagnosis may suffice if no genetic test is available. WB -- Take out the G'RBAGE to reply wubbabubbazG@RBAGEyahoo.com Thanks for all the input, I really appreciate it. I looked over my medical plan and the details don't really say much that I can relate to my particular case. Like it was said here, there is some dental coverage relating to accidents, but no mention of a genetic disorder such as this. I have made some phone calls and it seems the best I can do is to have my dentist submit the claim and see what happens. A woman I spoke with on the phone, who has something to do with the administration of my insurance, says I should have the dentists/doctors write letters supporting my case. She suggests I gather the letters and send them myself. I know my dentist is top notch and knows his stuff, but if anybody here has some good arguments supporting "medical necessity" for such a case, please let me know. Any additional info or tips is GREATLY appreciated. Thanks, --Dan > Don't know if there's a genetic test yet, but the signs are pretty > characteristic, so it should be fairly easy to diagnose. According to my old [quoted text clipped - 23 lines] > 718-258-5001 > http://www.dentaltwins.com > Thanks for all the input, I really appreciate it. I looked over my medical > plan and the details don't really say much that I can relate to my [quoted text clipped - 11 lines] > Thanks, > --Dan I would say that the letters should stress the components of care that are needed due to the genetic condition. If the letters just say that there are old crowns and they have decay, it may never get even a look as a medical issue. The letters should describe the condition, perhaps include letters from an MD if applicable, and stress the genetic component of the condition. Don't know if it will work, but I hope so. Some companies will simply say the work being done is dental work, and the reason why it is being done doesn't matter. Good luck T > Thanks for all the input, I really appreciate it. I looked over my medical > plan and the details don't really say much that I can relate to my [quoted text clipped - 11 lines] > Thanks, > --Dan Just yesterday spent a couple of hours with a 7-year old classmate of my daughters and her mother, both of whom have dentinogenesis imperfecta (they are not patients of mine). They don't have much money and will be seeking dental help soon. Let us know how you make out. If I am asked to help with these two ladies I will post what I find out. Steve > > Don't know if there's a genetic test yet, but the signs are pretty > > characteristic, so it should be fairly easy to diagnose. According to my [quoted text clipped - 33 lines] > > 718-258-5001 > > http://www.dentaltwins.com -- Mark & Steven Bornfeld DDS Brooklyn, NY 718-258-5001 http://www.dentaltwins.com I realize this thread is old, but I just found this website. I have DI and was just able to get my treatment (crowning all of my remaining teeth) covered by my medical insurance. I live in NYS and have CDPHP insurance, which has a clause that says they will pay for dental care only if it's a congential disorder....DI is. My DMD called their Resource Coordination Dept and explained the condition to them. I believe he then faxed my x-rays, etc. They approved treatment within 24 hours. If anyone would like more information, please feel free to email me at HeatherML21@hotmail.com. Good luck. >> Thanks for all the input, I really appreciate it. I looked over my medical >> plan and the details don't really say much that I can relate to my [quoted text clipped - 22 lines] >718-258-5001 >http://www.dentaltwins.com |
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