Wood v. Thompson
United States Court of Appeals for the Seventh Circuit
246 F.3d 1026 (2001)
Floyd Wood (plaintiff) required heart valve replacement surgery. However, Wood had a gum infection that could infect the replacement valve if left untreated. Accordingly, Wood’s heart surgeon ordered Wood to have the infection treated before the surgery. Ultimately, Wood’s dentist was required to extract 14 teeth and reconstruct Wood’s jaw to completely resolve the infection issue. Once the gum infection was gone, the surgeon performed the heart valve replacement surgery. Wood’s dentist submitted an insurance claim under Part B of the Medicare program. The dentist requested $1,156 for the outpatient dental procedure, noting that it had been a medically necessary part of treating Wood’s heart valve problem. However, Medicare Part B did not cover dental treatments, and the Medicare insurance carrier denied the claim. Wood appealed the coverage denial to a Medicare hearing officer, an administrative-law judge, and a federal district court. Each judicial body affirmed the denial of the dental-treatment claim. Wood then appealed to the Seventh Circuit, arguing that the dental treatment was a medically necessary part of treating his heart condition.
Rule of Law
Holding and Reasoning (Cudahy, J.)
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