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Major Medical & Sjogren's causing tooth decay

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Junior Member
What is the name of your state?What is the name of your state? South Carolina

I was diagnosed with Sjogren's disease secondary to Lupus in 1986. Sjogren's causes severe dryness in the mouth, which then causes tooth decay. My teeth have been filled until they can be filled no more. Since 1988 I have had 13 teeth crowned due to this severe decay and have more pending. I wrote a letter to Blue Cross/Blue Shield of SC asking that these crowns be paid for under my health insurance and was denied. My primary care physician and dentist also wrote letters attesting to my condition.

I can appeal their decision. Where would I find if any precedence exists in this matter? I am sure other folks have the same situation and know there must be a way to prove to BCBS the error of their ways. I just need someone to point me in the right direction.

Thanks for your help.


Does your health insurance policy say that it will cover dental problems that were secondary to medical problems? Your policy is your guide to what will and will not be covered.


Senior Member
purple is correct. It all depends whether the policy states dental work will be covered if it is secondary to medical problems. Most medical plans I've seen specifically exclude coverage for dental problems except limited and very specific types of oral surgery.


Junior Member
Thanks to Beth and Purple for your answers.

You are both correct that the policy does exclude dental problems secondary to illness. However, I learned a long time ago that it's not what you say you do that counts....it's what you practice. That's why I asked if anyone could tell me where I might find out if BCBS ever made an exception for someone in the past. Is there someplace where I might search? I tried as many ways as I could think of with Google, but came up empty.

Thanks again for your help.


BCBS is not a company with consistent policies; it is a professional association independent insurance companies join. Furthermore, within each insurance company, there are 100s of different policies, all with different coverage rules. My point is, Googling other coverage determinations won't help your situation.

The only thing you can do is to follow your insurer's internal appeal process. If they uphold their decision, you're out of luck. Your insurance policy is a legal contract, and you agreed to its conditions.


Junior Member
Thanks, Purple, for the answer. I will start working on my appeal right away. Your help is very much appreciated.


Junior Member
My mom (who lives in Colorado and has Kaiser Permanente) is going throught exactly the same thing as The Badger. She has used up her lifetime dental insurance benefit and I too feel that since Sjogrens is a medical condition that affects her mouth and teeth it ought to be covered by her health insurance. I'm curious to know if you had any luck in your appeal or any insight as to what I can do to help my mom obtain medical coverage.
If anyone else has any ideas on how to approach this please let me know. I feel very sorry for her. The dental expense adds to the pain of the actual procedures incurred.
Thank you!

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