amelioblastoma
in [Dentistry]
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From: whiterabbit on 9 Dec 2005 20:39 My DDS removed a lesion that has been biopsied as an amelioblastoma. It penetrated the bone from inside of the jaw to outside. Biopsy did not include any normal bone/tissue so it is assumed that excision did not get back to "good" bone. DDS is going to review actual cell sample as there is a suspicion that it may be aggressive since actual lesion occurred in about a 2 month time period in a cycst like formation that then extended into a flattened formation that extended frontally to front teeth and down to botton of jaw. I read a posting that stated that left untreated, a person's ability to consume food would eventually fail and the person would effectively starve ( basically the tumor invades the entire oral cavity....frightening prospect). But my questions are more mundane. Anybody successful getting insurance to pay??? My DDS said, worse case basis, the extraction of the two teeth above the blastoma, the curettage, the bone implant and hosptialization would run $10k to 15k. My employer's (I'am disabled but still qualify under the employer's plan) self-funded plan, admisitered by CIGNA, excludes oral surgery for teeth and periodontium except for excision of epulis and extraction of unerupted impacted tooth. I get the feel from the DDS that we submitted it to the insurer and if it gets paid, it gets paid; if it doesn't than I bill you (i.e., takes himself out of the reimbursement detail.) I guess basic question is, is this a periodontium issue? I tried web resources for definition and I simply got lost in the detail. From what the DDS assistant indicated, the initial excision would not qualify as an epulis nor would any future surgery. So, I'm back to the financing question. I qualify for Medicare Part B but have not enrolled since I have an employer plan. Would Medicare cover? I know I should be more concerned with the health aspect of it, but $15k is not an easy expenditure.
From: pdurant on 9 Dec 2005 21:51 My (then) 18 year old son had an right maxillary ameloblastoma 2 1/2 years ago. His surgery was done by an oral surgeon and involved removal of 4 teeth, 1/3rd of his upper jaw bone, about 1/4th of the roof of his mouth and sinus bone & some cheek tissue. You can search "ameloblastoma" on this group and find more details if you wish. The reason I am responding to you is to let you know that our medical insurance covered everything - even though we don't have any dental coverage. I believe an ameloblastoma is considered a medical condition rather than a dental condition. We are in the process right now of evaluating my son for possible jaw reconstruction and our medical insurance company has given verbal approval for the CT scan and skull model that are necessary to determine the next step and they give us no reason to doubt that they will pay for the surgery, prothesis and implants to restore his mouth to near-normal functioning. Due to the aggressive nature of ameloblastomas, I would be very wary of having a regular dentist treat this. Is your DDS referring you out to a surgeon or is he planning to do it (that's what your post sounded like to me)? It is necessary to remove the tumor and 1 cm of healthy tissue to insure clean margins. If any tumor cells remain, there is a great chance of the tumor returning. I'm part of an ameloblastoma support group online and there are a number of people on there that had their tumors recur 10 to 20 years after initial removal due to inadequately aggressive treatment when they were first diagnosed. Of course, more is known about ameloblastomas now than then when it seems treatment involved tumor removal and scraping the bone but not removing it. I hope you get good news about the financial end of this - the disease is upsetting enough without having to worry about how to pay for the treatment. Good luck and please let us know how you make out.
From: Steven Bornfeld on 9 Dec 2005 22:29 whiterabbit wrote: > My DDS removed a lesion that has been biopsied as an amelioblastoma. It > penetrated the bone from inside of the jaw to outside. Biopsy did not > include any normal bone/tissue so it is assumed that excision did not get > back to "good" bone. DDS is going to review actual cell sample as there is a > suspicion that it may be aggressive since actual lesion occurred in about a 2 > month time period in a cycst like formation that then extended into a > flattened formation that extended frontally to front teeth and down to botton > of jaw. I read a posting that stated that left untreated, a person's ability > to consume food would eventually fail and the person would effectively starve > ( basically the tumor invades the entire oral cavity....frightening prospect). > But my questions are more mundane. Anybody successful getting insurance to > pay??? My DDS said, worse case basis, the extraction of the two teeth above > the blastoma, the curettage, the bone implant and hosptialization would run > $10k to 15k. My employer's (I'am disabled but still qualify under the > employer's plan) self-funded plan, admisitered by CIGNA, excludes oral > surgery for teeth and periodontium except for excision of epulis and > extraction of unerupted impacted tooth. I get the feel from the DDS that we > submitted it to the insurer and if it gets paid, it gets paid; if it doesn't > than I bill you (i.e., takes himself out of the reimbursement detail.) I > guess basic question is, is this a periodontium issue? I tried web resources > for definition and I simply got lost in the detail. From what the DDS > assistant indicated, the initial excision would not qualify as an epulis nor > would any future surgery. So, I'm back to the financing question. I qualify > for Medicare Part B but have not enrolled since I have an employer plan. > Would Medicare cover? I know I should be more concerned with the health > aspect of it, but $15k is not an easy expenditure. If this is being done on an in-patient basis, it almost certainly will be covered under any hospitalization-major medical coverage you have, rather than dental. This is definitely NOT periodontal. Speak to the benefits manager for your employer and make sure you do whatever you need to do preoperatively, esp. if your surgeon cannot guide you here. Good luck, Steve
From: whiterabbit on 9 Dec 2005 22:34 pdurant wrote: >My (then) 18 year old son had an right maxillary ameloblastoma 2 1/2 >years ago. His surgery was done by an oral surgeon and involved >removal of 4 teeth, 1/3rd of his upper jaw bone, about 1/4th of the >roof of his mouth and sinus bone & some cheek tissue. You can search >"ameloblastoma" on this group and find more details if you wish. > >The reason I am responding to you is to let you know that our medical >insurance covered everything - even though we don't have any dental >coverage. I believe an ameloblastoma is considered a medical condition >rather than a dental condition. We are in the process right now of >evaluating my son for possible jaw reconstruction and our medical >insurance company has given verbal approval for the CT scan and skull >model that are necessary to determine the next step and they give us no >reason to doubt that they will pay for the surgery, prothesis and >implants to restore his mouth to near-normal functioning. > >Due to the aggressive nature of ameloblastomas, I would be very wary of >having a regular dentist treat this. Is your DDS referring you out to a >surgeon or is he planning to do it (that's what your post sounded like >to me)? It is necessary to remove the tumor and 1 cm of healthy >tissue to insure clean margins. If any tumor cells remain, there is a >great chance of the tumor returning. I'm part of an ameloblastoma >support group online and there are a number of people on there that >had their tumors recur 10 to 20 years after initial removal due to >inadequately aggressive treatment when they were first diagnosed. Of >course, more is known about ameloblastomas now than then when it seems >treatment involved tumor removal and scraping the bone but not removing >it. > >I hope you get good news about the financial end of this - the disease >is upsetting enough without having to worry about how to pay for the >treatment. Good luck and please let us know how you make out. I'm sorry for the pain that your son must be going thru. My problem seems to be in the early stages. To answer your question, my DDS will be doing the surgery. He is also an oral surgeon. I'm a newbie in this area so, to me an oral surgeon is the person who shouuld do it? Who did your son's? Is there another specialty surgeon for this? My regular health insurance plan does provide coverage for oral surgery but limited to TMJ and the other procedures (epulis and impacted unerupted teeth). The insurance benefit plan seems to be very limited in this area. Could you give me the address for the support group, or is that limited to individuals who have (versus going to have) extensive surgery? Thank you for your response.
From: Steven Bornfeld on 9 Dec 2005 22:41
whiterabbit wrote: > pdurant wrote: > >>My (then) 18 year old son had an right maxillary ameloblastoma 2 1/2 >>years ago. His surgery was done by an oral surgeon and involved >>removal of 4 teeth, 1/3rd of his upper jaw bone, about 1/4th of the >>roof of his mouth and sinus bone & some cheek tissue. You can search >>"ameloblastoma" on this group and find more details if you wish. >> >>The reason I am responding to you is to let you know that our medical >>insurance covered everything - even though we don't have any dental >>coverage. I believe an ameloblastoma is considered a medical condition >>rather than a dental condition. We are in the process right now of >>evaluating my son for possible jaw reconstruction and our medical >>insurance company has given verbal approval for the CT scan and skull >>model that are necessary to determine the next step and they give us no >>reason to doubt that they will pay for the surgery, prothesis and >>implants to restore his mouth to near-normal functioning. >> >>Due to the aggressive nature of ameloblastomas, I would be very wary of >>having a regular dentist treat this. Is your DDS referring you out to a >>surgeon or is he planning to do it (that's what your post sounded like >>to me)? It is necessary to remove the tumor and 1 cm of healthy >>tissue to insure clean margins. If any tumor cells remain, there is a >>great chance of the tumor returning. I'm part of an ameloblastoma >>support group online and there are a number of people on there that >>had their tumors recur 10 to 20 years after initial removal due to >>inadequately aggressive treatment when they were first diagnosed. Of >>course, more is known about ameloblastomas now than then when it seems >>treatment involved tumor removal and scraping the bone but not removing >>it. >> >>I hope you get good news about the financial end of this - the disease >>is upsetting enough without having to worry about how to pay for the >>treatment. Good luck and please let us know how you make out. > > > > I'm sorry for the pain that your son must be going thru. My problem seems to > be in the early stages. To answer your question, my DDS will be doing the > surgery. He is also an oral surgeon. I'm a newbie in this area so, to me an > oral surgeon is the person who shouuld do it? Who did your son's? Is there > another specialty surgeon for this? My regular health insurance plan does > provide coverage for oral surgery but limited to TMJ and the other procedures > (epulis and impacted unerupted teeth). The insurance benefit plan seems to > be very limited in this area. Could you give me the address for the support > group, or is that limited to individuals who have (versus going to have) > extensive surgery? Thank you for your response. An oral and maxillofacial surgeon is the appropriate person for treating your condition. I cannot speak to the details of your insurance, but I wouldn't worry too much about few oral surgical procedures listed on your policy. This is SURGERY, and while it is a normal part of oral surgical practice, as an inpatient procedure it should be covered, assuming you have a good hospitalization/major medical coverage. Good luck, Steve |