Will medicare pay for oral surgery due to autoimmune disease--scleroderma, etc.

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Veteran Member

Date Joined Dec 2005
Total Posts : 1950
   Posted 2/3/2012 1:00 PM (GMT -6)   
Haven't been on for a while, been winding down lately, can't seem to get health under control. Can you tell me if medicare will pay for oral surgery for your jaw getting smaller? I got bad infections around my teeth and the backmost teeth are jamming up against my crowns and some starting to overlap and the whole mess is infected. Dentist wouldn't pull the backmost teeth for me because he said they are "healthy" teeth. He said I need an oral surgeon, who told me that most of the time they hav to do the extraction of the backmost molars.  Anyway, I am in bad pain and been to ER twice and doctor once.  On the immunosuppressants, the infection just comes right back, no matter how strong the antibiotics are or how long I take them.
I just need to know if anyone has had any luck in getting medicare to cover extractions due to the jaw shrinking due to disease (as opposed to breaks or whatever).
Love yall, Marji

New Member

Date Joined Jan 2012
Total Posts : 14
   Posted 2/4/2012 12:16 PM (GMT -6)   
Is it periodontitis, I am an assistant and gum disease does eat away at the bone surrounding the teeth, but it has never been linked to anything. It is an infection that is all over your mouth and the best way to keep it from getting worse is gum therepy but that doesn't sound like what you are describing. If you still have your third molars (wisdom teeth) then those are generally taken out and can cause crowding in the rest of your teeth. If it is your wisdom teeth that are bothering you then antibiotics wont help unless there is some real infection in there but getting them out is best. Not sure on the whole medicare thing, my guess is you would have to prove without a doubt that it is linked and unfortunately that is going to be impossible.

Veteran Member

Date Joined Jan 2007
Total Posts : 607
   Posted 2/7/2012 2:19 AM (GMT -6)   
I am not sure about Medicare. Can you check or phone them and ask? My private insurance at first refused to pay for my ophthamologist bill because they claimed that my insurance did not cover eye check. I then had obtained a doctor's letter that I needed to have an eye check due to the lupus drug I was taking (Plaquneil), and they still refused. I then filed a formal complain to the Insurance Bureau, and they paid my bill right away. For private insurance, they should be able to cover things that are medically related, but I am not sure about Medicare.

Veteran Member

Date Joined Dec 2005
Total Posts : 1950
   Posted 2/15/2012 8:48 PM (GMT -6)   
I found out that there is a court case pending on this exact thing with CMS (medicare) for people with sjogrens and scleroderma to be covered through medicare for tooth breakage or extractions again at least.  I wrote to support a favorable decision, as this will ultimately save mmoney for medicare since people with bad teeth end up in the ER or having heart surgery eventually.
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