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Will Medicare pay for dental implants needed as a result of my autoimmune disease?

Consumer Reports News: July 29, 2011 07:08 AM

Q: I have Sjogren’s Syndrome, an autoimmune condition that has attacked my salivary glands. As a result, my teeth have been destroyed by the lack of saliva. Dentists say a bridge of false teeth will not stay in place because there is no saliva to form a suction lock. I must have implants instead. Can I get any help from Medicare with this expense, as it is a medical condition that caused the loss of my teeth?

A: Probably not, but you should try anyway. In fact there is a class-action lawsuit currently pending that aims to get Medicare to change its no-dental-coverage policy for people in your situation.

We contacted Sally Hart, an attorney for the Center for Medicare Advocacy, who filed the suit in a federal district court in Phoenix, Ariz., to learn more. She explained that by law, Medicare does not cover “routine” dental services. It takes a hard line on this, refusing to cover even situations like yours of massive tooth decay caused by illnesses or the complications of treatment for illnesses like head and neck cancer.

“We have argued that this is a misinterpretation of the Medicare statute,” Hart said. “We think that beneficiaries who require extensive dental services because of damage from Sjogren’s Syndrome, as well as cancer radiation treatment and other conditions that destroy the production of saliva, should not fall within the exclusion.”

Why is all of this important for you? If Medicare refuses to reimburse you for your implants, and you then file an appeal, you will automatically become a class member if the judge certifies the Arizona lawsuit as a class action. Then, if the suit is successful, you will get coverage, Hart said.

Understand that you have to receive the implants before seeking reimbursement or filing the appeal. Here’s how to submit the bill to Medicare Part B. And here's how to file an appeal.

Nancy Metcalf

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