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Medicare does not cover dental. My Dad is recovering from sepsis. The doctor is almost certain it came through his gums. His bottom front teeth are all broken and rotted and the gums are badly swollen and inflamed. The doctor says the teeth need to be pulled or he is at risk for more infection. My Mom said that Medicare will not cover this because it is dental, my sister who is health proxy told her this. I was under the impression that as long as there was a medical need, medicare would pay for oral issues. Is that true? If so how would one go about appealing to Medicare?

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My husband had a tumor so the teeth (and bone) had to be removed. It seems to me that having them removed because of sepsis would be in that category also. This is done in the hospital under general anesthesia
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I have never heard of an ENT specialist extracting teeth
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Great suggestion amott6! We will look into that. If that does not work I think we have found an oral surgeon who will reduce the cost and let him pay on time. PLUS we just got some fantastic news. My sisters dentist does about three sets of pro bono dentures each year and she has offered to make up my new Dads set after his remaining teeth are pulled. What an angel!!
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You might get some help if you take him to an Eye, Ears, Throat specialist because if he pulls the teeth and treats the sepsis, he is covered by Medicare, but dentists are not. I recently got coverage for a biopsy inside my mouth by going this route. Might be worth looking into.
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Thanks everyone and no problem HelperMom! I get confused with these threads sometimes too :) So much to read and keep in mind when I respond. Sigh
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Oh, sorry! I just read your note again and see that he's already seen a doctor and is recovering from the sepsis. Phew.
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Tryingmybest, just a thought, but have you taken your dad to an emergency room? They could treat the acute sepsis and might have a referral who would treat patients with less resources. Also agree with the suggestion to look at CareCredit, although they might not approve your father based on his credit rating. (They closed my dad's account based on his late payment history, which was entirely caused by the dementia. It's so frustrating that banks and credit card companies don't understand the difference between someone who misses payments because of dementia and someone who just doesn't care!) Anyway the ER should treat the sepsis for sure, because as someone else mentioned it is very serious and can cause death.
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Medicare does not help with assisted living. Natural teeth are best, but can cost a fortune to replace/repair. Actually the least expensive route is having them pulled and adding dentures which are costing around $250 in some dental offices. One could also go to Los Algodones, Mexico near Yuma, AZ and the rates are significantly cheaper, however, you pay for what you get. Millions of seniors flock there for their cheap dental work, but beware of the work!
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Along that same line, does Medicare help with Assisted Living expenses? I've been told they do not.
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Ferris 1, it's a little late to put the horse back into the barn. Too late to take care of his teeth now so let's take care of the acute situation. IF he has other teeth left, he needs those treated as well. Perhaps dentures are a solution if the periodontal disease is very severe. Again there are agencies that can offer low cost options. Check with the Area Wide Agency on Aging too
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As I said before call your state dental board or state dental association for lo cost options. May times there are FREE clinics for extractions. I teach at a dental school and it is often not easy to get emergency extractions and they aren't cheap by any means, just less than a private office.
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Thank you I will check into these suggestions. This is a bit of an emergency. We recently found out my Dad and Mom have been living on credit cards and they are in deep trouble financially. My Dad is a small business man and he is very stubborn and private about his finances, I've known things were going south for a while but I had no idea how badly. That would be why he did not have his teeth taken care of before this. My parents do own some property and hopefully they can sell that, pay off their debts and still have something left over for their care but it is not looking good. The properties they own are commercial and not high value so I shudder to think what they would get if they have to short sell. Meanwhile they are still paying overhead costs for the business...utilities, property fees (one is a business condo) upkeep and property taxes with hardly any income. It's a huge mess.

I don't know how much the oral surgery is going to be but I do know that my husband and I can't cover it even if they could pay it back at a future date. The dentist will not agree to a payment plan because of my Dads bad credit. He needs to have it done before they stop the antibiotics for the sepsis which is a little less than three weeks away.
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Go to www.medicare.gov for answers. You will have to appeal for the decision to be reversed regarding dental care which results in a medical crisis, however, your father should have taken care of his teeth in the first place so as not to get the infection. Oral health is directly related to heart health. I suggest getting the credit card CareCredit by GE Capital which will cover dental, cosmetic procedures and vet bills at a no interest for a year agreement. Just make sure you pay MORE than the minimum payment each month or the card will charge ACCRUED interest from the day you used the card. I got hit with a $1360 charge on my hearing aids, but if you pay off the entire amount within a month they will waive those charges (you have to ask for and be granted this extension). If he is a veteran I still do not think he will be covered, but we can pay for Delta Dental insurance (I thought it was too expensive). We also have a dental school here in Glendale, AZ Midwestern University which treats people at a reduced rate, so check and see if you have a dental school nearby. After many procedures and am still in dental care treatment, the only time I got reimbursed for dental surgery was being denied by Medicare and then Tricare for Life reimbursed my osteonecrosis due to Fosamax (for osteoporosis) usage, but that process took me one year of going back and forth with Tricare. Take care of your teeth always!!! Sepsis is nothing to fool with, it can cause death.
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If you live near a dental school, they will usually do dental work for a reduced cost.
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I don't know what state yo live in but there are resources for people who need dental care and can't afford it. I am a dental hygienist and educator at a dental college. In my state, I would suggest calling the local State Dental Association. They should have info for low cost care clinics. Medicare doesn't pay for dental. But Medicaid pays only for extractions for adults. Yes the teeth are connected to our blood supply which is why dental infections can affect the body. Sadly the insurance and health community think teeth don't matter in the scheme of our overall health. Good luck and please let us know if you found help. It is vital he gets these taken care of
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Thank you. I will call today
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Ask your dentist's office. They do the billing, and they will know what is covered.

You might also call your state's Senior Citizens Law project. Every state receives a grant for legal services to advise seniors.
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I was hoping someone here might have information about this but if not could someone advise me where I might go to find answers? thanks
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