Ross
Well-known member
No because it's not his area of speciality. Here are the words of my advocate and his attorney boss:
Ross;
I was speaking with my supervisor and I wanted to bring up two points with you:
1) If Mercy Medical Low-Income Clinic is not in Primetime’s network and you get the procedure there, you will not be able to appeal Primetime’s post-service denial of payment.
2) You may want to discuss with your doctor the possibility of being admitted to the hospital and having your teeth removed because of your heart condition. That way your dental work would be covered under Medicare Part A. Here is the relevant Medicare statute about dental care coverage:
(a) Notwithstanding any other provision of this title, no payment may be made under part A or part B for any expenses incurred for items or services—
* * * *
(12) where such expenses are for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth, except that payment may be made under part A in the case of inpatient hospital services in connection with the provision of such dental services if the individual, because of his underlying medical condition and clinical status or because of the severity of the dental procedure, requires hospitalization in connection with the provision of such services;
42 U.S.C. § 1395y.
Ross;
I was speaking with my supervisor and I wanted to bring up two points with you:
1) If Mercy Medical Low-Income Clinic is not in Primetime’s network and you get the procedure there, you will not be able to appeal Primetime’s post-service denial of payment.
2) You may want to discuss with your doctor the possibility of being admitted to the hospital and having your teeth removed because of your heart condition. That way your dental work would be covered under Medicare Part A. Here is the relevant Medicare statute about dental care coverage:
(a) Notwithstanding any other provision of this title, no payment may be made under part A or part B for any expenses incurred for items or services—
* * * *
(12) where such expenses are for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth, except that payment may be made under part A in the case of inpatient hospital services in connection with the provision of such dental services if the individual, because of his underlying medical condition and clinical status or because of the severity of the dental procedure, requires hospitalization in connection with the provision of such services;
42 U.S.C. § 1395y.
