You Wanna Know How Wealthy I Am? Just Look At My Teeth

Almost one year ago I wrote an article
about the difficulties a local parent faced
when finding specialty dental care for her
child. I worried that the state All Kids
Insurance Program, introduced in July
2006, would not address her difficulties,
since many dentists were refusing to join
the program. Alas, my concerns bore out:
parents are still struggling to find local dentists who will
take the All Kids insurance.
In an attempt to enroll more dentists, the state raised
dental reimbursement rates. Below is a comparison
between the old and the new rates.
In addition, dentists serving All Kids enrollees were
given top priority for reimbursement. These changes
stemmed from the Memisovski v. Maram (2004) lawsuit
that addressed Illinois Medicaid’s failure to provide
enrollees (0-18 years of age) with medical services “to an
extent equal to that at which such services were available
to the general population” (www.illinoisaap.org/
Memisovski.pdf). The presiding judge agreed that the state
had failed its obligation to provide children with timely
access to preventive care equal to privately-insured children.
The judge proposed a plan that would address
provider reimbursement rates, payment cycles, Medicaid
“hassles,” provider and client notices, provider referrals,
and other issues. However, this plan did not directly
address specialty care.
The state has retained a consultant to determine what
additional steps are needed to access specialty care. The
results were due last year but according to Scott G.
Allen, Executive Director, Illinois Chapter, American
Academy of Pediatrics:
“IDHFS has not yet completed the study – it was
delayed and they’ve only recently decided on their methods
and started the process. The best contact for information
on this would be a group called Health and Disability
Advocates (www.hdadvocates.org) – staff there participated
in the lawsuit that is requiring the study, and I believe
they are in contact with HFS about its progress.”
PRESENT DENTAL OPTIONS FOR ADULTS ON A
TIGHT BUDGET
While the state is striving to meet children’s dental needs,
it has yet to make significant progress in helping their parents.
Although the improved reimbursements apply to
adult care, parents enrolled in the state’s Family Care
Insurance Program still face the same paucity of dentists
when seeking care for them selves. Like many adults on a
tight budget, they get their teeth cleaned via one of the following
dental programs:
1. Parkland College Dental Hygiene Clinic for $10
(351-2221).
2. Champaign County Christian Health Clinic
(398-2914) offers free dental care on Tuesday
evenings (Call @ 5:30 pm on Monday to make an
appointment).
3. Champaign County Health Care Consumers (352-
6758) can get you an appointment with local dentists
participating in their sliding-fee program.
The Parkland students give very good cleanings because
they want to get a good grade and both CCCHC and
CCHCC offer staff who appear genuinely concerned for your
plight, offering emotional support if you want it. But in each
case, especially Parkland, you have to block off a work day
for appointment(s) and you won’t get immediate care (waitlists
are 6 months long). Also, if you need specialty care (like
a root canal), you won’t receive that care through Parkland or
CCCHC. CCHCC is a potential route to specialty care.
I met a guy last summer who held only backroom jobs
because he was missing several front teeth. “Nobody wants
a toothless guy for a sales clerk,” he said. But the backroom
jobs he held did not provide the dental coverage or
the income he needed to get new teeth. He relied on public
assistance to make ends meet. CCHCC connected him
to a local dentist that gave him new teeth at an affordable
rate. Now he’s climbing out of his financial rut and saving
taxpayers from donating more public assistance money.
A STITCH IN TIME SAVES NINE?
Could using taxpayer dollars to cover specialty dental care
(as in universal full dental coverage) actually save taxpayers
from other hidden costs? Consider the following cases
where these adults had state-funded dental coverage.
Case 1: (36-year-old mother in a nearby town): “I’m
pretty lucky because my kids qualify me for All Kids. But
when I had a toothache it was almost impossible to find a
dentist who takes All Kids, let alone one who could see me
right away. I can’t tell you how much time I lost from my
kids and work to take care of this.”
As a check I called Doral Dental Services Illinois @ 1-
888-286-2447 then visited www.doralusa.com to find a 3-
page list of dentists who are supposedly participating in the
All Kids Family Insurance Program. I spent one whole day
calling several of the dentists on this list and could not get
an appointment for someone receiving Medicaid or All
Kids because most of them are
no longer accepting the insurance.
For example, Dr. Chung at
the Dentistry by Design clinic at
1905 Convenience Place is listed
on the All Kids Website, but they
have an enormous waiting list
and, as of April 1st, 2007, they
stopped accepting the Medicaid/
All Kids insurance, even for established patients. Evidently
it was not the state’s responsibility to warn this mom
and she didn’t find out until she called Dentistry by Design.
“There must be something wrong if I don’t even know
that my dentist is dropping me,” this mom said. (Rest
assured, not all programs abandon clients. When heading
the Rural Dental Health Program, Lisa Bell was required to
send patients a letter if she would no longer be providing
their child’s care, a letter that included a list of one or two
providers who might be able to help address their needs as
well as allowing them to seek “emergency” care through
her organization for 30 days.)
In short, finding a dentist for this mother was an
extremely frustrating process, even for a person who didn’t
have a toothache or children to manage. How much did
taxpayers cover in indirect costs for this case (e.g., this
mother’s lost wages, impact of parent’s financial and health
stress on her children, etc.)?
Case 2: (migrant worker in the community): This
mother needed her tooth fixed because “there was a problem
with the nerves.” She couldn’t see the dentist while
she was pregnant so she called Dentistry by Design to
schedule an appointment after her baby’s due date. “They
said to call back after my baby is born.”
Like many offices, Dentistry by Design only made
appointments for Medicaid patients two weeks in advance.
But this woman only had dental care through the Moms &
Babies Program while she was pregnant and for 2 months
following the birth of her baby. She called during the early
months of her pregnancy to schedule an appointment that
would fall within the two-month window after her baby’s
birth, but the dental office wouldn’t let her. “I called back
after my baby was born but they did not have any openings
for me.” She was put on a waiting list with 500 other
people. As you might expect, she didn’t get the appointment
before the 2-month window closed and she is now
seeking a way to fund the root canal she likely needs. I
hope the underground dentist she knows in Chicago does
a great job so she won’t end up in the emergency room to
use even more state dollars or spend even more time away
from the child the state already supports.
Case 3: (72-year-old grandmother on Medicare living
just south of Champaign): She paid $150 for a botched
filling; it hurt for months and she needed a specialist to
have it capped. “I couldn’t afford the $500 so I had it
pulled for another $150.” Since then the adjacent tooth
has fallen out. “Now I can’t afford to go back to the dentist
and I have all these holes in my mouth.”
She expects she’ll have to get false teeth. Will a set of
false teeth cost taxpayers more money than having saved a
single tooth in the beginning? It seems that this patient
doesn’t even know if Medicare will cover false teeth. “You
never know what they cover until you go. They only cover
a portion of certain things. It’s like most insurance where
they only pay 50% of the provider’s fee and by the time
you pay the insurance you don’t have money for the 50%.”
Case 4: (28-year-old University of Illinois Graduate
student): The University lumps graduate students with
undergraduate students so they can offer a fairly cheap
“student” insurance plan, but it is aimed at 18-22 year-olds,
covering basic six-month cleanings and check-ups, not
preventive surgery. “My dentist referred me to a periodontist
who told me that I needed a surgery that would cost
over $2000. This procedure was not covered [even though
it] was preventing six of my bottom teeth from falling out! I
called the benefits office and was told, very frankly, that the
only thing I could do was to ‘wait until my teeth fell out’
and then file a health claim.” She sought a 3-month emergency
loan, but was unable to get money until the surgery
was complete. So she charged the surgery to a credit card.
She’s still paying it off nearly six months later and has taken
out more federal student loans to pay for the debacle. We
already know how consumer debt hurts our economy.
CONCLUSION
The bottom line is that accessing specialty dental care is a
real pain (pardon the pun) that involves more hidden costs
than people realize. Had any one of these patients been
dealing with a second diagnosis (diabetes, cancer, etc.)
then the costs of an untreated infection could have potentially
cost taxpayers even more. In some cases, it can leave
blood on our hands (see the Washington Post, March 3,
2007, for a story regarding a poor Maryland boy who died
after a tooth infection spread to his brain).
I’ll leave you with one final thought. If you want cheaper
dental care, try using the good ole’ free market to trigger
a price war (e.g., dentists might offer lower rates or a payment
plan for uninsured patients who pay out-of-pocket
because they don’t want to mess with insurance paperwork).
Although the prices will still take unbearable
amounts from your income, it couldn’t hurt to try bartering
a deal and you might get in sooner than 6 months. Let
me know if it works.