In re Doe

No. 000-44-0034 (SSA Office of Hearings & App. Apr. 5, 1996). ; Clearinghouse Number: 51574

Description

Medicare Claimant Entitled to Coverage for Dental Implants

Abstract

The administrative law judge (ALJ) has ruled that claimant is entitled to Medicare coverage for tooth extraction and dental implants. Claimant, a 69-year-old widow, sustained severe facial injuries in an automobile accident. She had reconstructive surgery, including a total jaw replacement Because her teeth had advanced periodontal disease they had no occlusion necessary to support her prosthesis, and because of her injuries she could not wear a conventional mandibular denture. The fiscal intermediary, contending that the dental procedures she required were not covered under Medicare, denied payment for her tooth extraction and dental implants. Claimant appealed. The ALJ held that claimant’s need for the implants arose from the severe facial injuries she sustained in the accident. Holding that the dental procedures were not solely to treat a dental problem but integrally to support claimant’s prosthesis, the ALJ approved Medicare coverage for the implants.

Additional Information

Attorney Information
Appellant represented by Rural Legal Services of Tennessee, Inc., P.O. Box 5209, Oak Ridge, TN 37831.
Docket Date
1996-04-05 00:00:00+00:00

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