A Brief Update On My Condition...

[Robert101]

Hello all  

Well, it's been a little while since I last posted. In fact, the last post I made was on the old board.

Anyway, to refresh some memories here, my original post on October the 7th, 2005 had been the following:

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Hello folks,

Well, the unexpected has happened. In just the first week of making an appointment to finally see a dentist, and of being informed of the extensive work involved, I have now lost two of my front teeth.  

As I'm typing this, I feel very traumatized and upset. For nearly 45 years, I had very healthy teeth with only 2 fillings. Then, I was diagnosed with stage 2 Hodgkins Lymphoma, went through the chemo and radiation, and have been currently in remission ever since. (4.5 years) That's the good news.  

The only problem unfortunately is the side effects that I am now just beginning to experience - mainly the near destruction of about 8 upper front teeth - with two already lost ( literally crumbled as I ate a dinner, and just a few hours ago, had what I thought was a "harmless" cookie snack )  

Because there had been at the time very little details on the net that I could find that fully explained the negative consequences of radiation/chemo on a persons dental profile, I only found out AFTER the fact, when it was practically too late to reverse the progressive destruction of tooth enamel/periodontal disease. My dentist of course inquired if I were aware of the potential hazards of post-chemo/rads on my teeth. When I told her that I had not been fully informed, she just shook her head in a combination of disappointment and sympathy, and went on with the business at hand - leaving me to wonder just how helpless and desperate my plight had become

At any rate, in just a few hours, I'm due to go in for another 2 fillings, with 9 more after that. Then the waiting game begins concerning the authorization of replacement crowns/root canals and God knows what else. According to my dentist, based upon prior experience, it will take from 4 to 6 weeks to hear from the Dental-Cal insurance people. They will either grant the estimated exorbitant expenses involved, or they will deny it either partly, or perhaps all of the request. In case the latter situation should transpire, I'm ready to vigorously appeal any unfavorable decision, and will plead that my health condition was completely beyond my control, and not simply due to irresponsible neglect.

Meanwhile, I'm pretty bummed out right now, even downright angry as I express more of my present feelings here. GRRRRR.....  

I apologize for venting like this, despite the fact that there are people here who are obviously going through potentially worse problems than me.

Nevertheless, I just LOATHE the thought of being put through yet another traumatic emotional wringer, when it all just seems so unfair, or at the very least, unnecessary.  

Sincerely,

Robert101

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OK - after posting that info, including all the followup responses, lot's of things have taken place since.

1) I finally got authorization from Dental-Cal to eventually perform 7 root Canals on my front teeth. The initial appointment is on January 5th.

2) A separate authorization is needed for the same number of crowns. This is where it gets critical, since the exorbitant expense involved may cause the folks at Denti-Cal to very well deny either parts of, or the entire authorization order altogether  

Hopefully, the latter case will not transpire, since there are at least a few viable teeth that can at least tolerate a crown lengthening procedure. This has been all but confirmed by not only my primary dentist, but also a "third party screening" dentist who took extensive pictures to verify for Denti-Cal insurance what exactly needs to be done.

So now I wait until January 5th, mindful of the fact that as the new year rolls around, Denti-Cal will reduce their benefits to an annual cap of $1800. Don't know exactly what the price of crowns are going for these days, but me thinks that maybe perhaps I can get by with at least one per annum without digging into my hard earned savings??? Hopefully, that number is larger. Otherwise, there's a strong possibility of upper plate/denture fittings - a possibility that me and my dentist had very briefly discussed during my last visit. Naturally, I would prefer crowns and not some bulky flippers to wear for the rest of my life. I'm sure others here can relate just as well and prefer the same outcome. But sometimes things don't go so well as initially planned, and so  I guess if it comes down to donning flippers on account of a lack of funds, then so be it. Better to have teeth in my mouth and *SMILE* for a change, than appear dour and speak with a discernable lisp, you reckon??    

Wishing all of you fellow "dental phobics" out there a very prosperous, healthy, and the Happiest of New Years    

Sincerely,

Robert101

 

[letsconnect]

Hi Robert, great to hear you're in good spirits, and that you got the authorization for those root canals ! Best of luck with the Denti-Cal folks (does the $1800 annual cap apply to everyone, or do they make exceptions?). In any event, I wish you the very best of luck with the authorization - let us know what transpires!

A Very Happy - and especially Healthy - 2006 to you, too !

 

[Robert101]

(does the $1800 annual cap apply to everyone, or do they make exceptions?).

Hello Letsconnect  

Yes indeed, there are certain exceptions. Here they are:

One of them is dentures, the others relate to what is described as "Maxillofacial complex oral surgery; Maxillofacial services, including dental implants and implant retained prosthesis; Services provided in long term care facilities; Emergency dental services; and services either provided through a managed care plan, or the federal government.

Robert101

 

[letsconnect]

Would you fall into any of those categories? Seems a bit weird to authorize one part of the treatment but not the other

 

[Robert101]

He he he   agreed.

With California bureaucracy though, anything can happen. They never cease to confuse me on anything

But whatever catagory I eventually fall under, at the end of the day I just want to be able to smile without too much embarrassment.  

And if comes down to being denied certain critical procedures, I have a right to appeal the decision, in which I will.     Basically, all beneficiaries are given 90 days prior notice to file for an appeals hearing.