HAMPSTEAD, NC (WECT) - Hank Grass is a cancer survivor. But today - it's Medicare he's still having to fight.
The 77-year-old had to have his salivary gland removed when doctors found cancer at the base of his tongue 3 years ago. Radiation and chemotherapy damaged Hank's teeth so badly that he had to have all but 3 of his bottom teeth extracted.
The tooth extractions and subsequent bridge work that allows him to chew cost Hank and his wife Jeri thousands of dollars. But Medicare won't reimburse them, saying his dental work was not medically necessary.
After spending years appealing Medicare's denial, Hank and Jeri contacted WECT for help. "They put you through such an ordeal with paperwork, paperwork, paperwork, and then you'd send paperwork, and they'd want more paperwork," Hank explained of the appeals process. "It seems as though Medicare is just trying to run you raged until you give up, and stop pursuing the issue."
We can appreciate his frustration. We contacted Medicare, hoping they could explain why dental problems doctors say were caused by Grass' cancer treatment wouldn't be covered.
Medicare's regional press officer in Atlanta informed us she couldn't discuss individual patients' cases, even if the patient signed a waiver, because it was a HIPPA violation.
The press officer then suggested that the patient call 1-800-MEDICARE for help. Jeri Grass says she's already spent untold hours on the phone, writing letters, and sending faxes to Medicare, all to no avail.
Jeri says the process has been maddening, but she's not giving up. "I will win my husband's case… I will fight til the end."
Raycom's corporate attorneys in Washington, DC tell us some of the information the Medicare press officer gave us is wrong. They say there is nothing in HIPPA legislation that prohibits Medicare from discussing a particular patient - as long as that patient signs a release.
Medicare declined to give us an interview, even about general coverage questions. But they finally did send us an email saying that with very limited exceptions, they don't cover anything that has to do with a patient's teeth.
Hank's dental problems do not appear to fall under the covered exceptions, even though doctors say his tooth decay was directly related to his cancer treatment.
Dr. Brady Semmel, the oral surgeon who has been helping Hank for the last several months, doubts any further appeals will result in Medicare reimbursing him.
Semmel says working with Medicare is very different than working with a private insurance company. For one, he says Medicare's coverage guidelines are vague, and it isn't always clear what procedures are and aren't covered.
"Sometimes you can lean on [a private insurance company] a little bit more, get an answer, because you are a consumer paying for that product," Semmel explained. "But with Medicare, you're working with a government agency, you can't really lean on them to kind of get answers out of them…Medicare can just say we're not covering it, and that's it."
Copyright 2012 WECT. All rights reserved.
322 Shipyard Boulevard