Posts Tagged ‘Medicaid’

A Personal Story: Insurance Issues – Melinda & Dave, Orford

Wednesday, April 4th, 2012

Melinda and Dave live in Orford, New Hampshire and have four children. Dave’s job offers dental insurance, but the rates are high. “We do have dental insurance available to us but. . . the family rate is so much higher than the individual rate, that unless you are going to have a lot of work done it doesn’t make sense financially to have the insurance for your kids. It’s cheaper to pay for expensive stuff out of pocket than to pay the higher rate for kids to be on our plan. . . We also have a dentist who we love that is not on the preferred provider list, and so it’s more expensive than if we had found somebody else. We’ve chosen to stay with her because we like her, we think she does good quality work, and we have a connection there. But it costs us more money.” Melinda explains that although the recommendation for cleanings is every six months, she tends to schedule cleanings for every eight months or so, in order to save money.

One of Melinda and Dave’s children, Angela, has special needs and is eligible for Medicaid. Because of her special needs she goes to a different dentist than the rest of the family, one who specializes in pediatric dentistry. Melinda feels that New Hampshire Medicaid is very good about dental care. They send regular reminders to go to the dentist, and they cover everything fully. Angela needed extensive sedated dental work done and it was all covered by Medicaid. Melinda’s one concern is that she feels that Angela’s dentist may have been able to catch some of her dental problems earlier if Melinda had started taking Angela to the dentist at a younger age. “I do think it’s kind of crazy how medical care and dental care are so separate. Even though we feel like we are getting really good medical care for her, her primary pediatrician was not saying, you need to take her to the dentist this year, even though she’s only one year old, just to see what’s going on. Somebody should have been telling us that. It wasn’t until it was to a crisis point that we took her to be seen and realized that there was all this horrible decay. I think that that’s not an uncommon story. I know that the pediatric dentist feels . . . that he’s seeing all these cases that should have been referred to him much sooner, and never were. I know he feels that the time line for checking out children’s teeth is too late. By the time they’re seen at age five, all their baby teeth have been in there for all this time and you could have seen decay happening but nobody ever looked.”

Illustration by Dennis Pacheco.

A Personal Story: NH Medicaid is Crippling – Jason, Lebanon

Monday, April 2nd, 2012

Jason is 34, with four children, and lives in Lebanon, New Hampshire. Jason’s daughter was born with Spina Bifida, which means, among other things, that her teeth are softer than most people’s and they are more susceptible to decay. At four or five years old she needed some extensive work done. Jason explains: “We had a dentist in Claremont, and with a busy schedule (my wife and I both work) and we have four kids we’re chasing around and bringing back and forth to different appointments. One of the appointments slipped our mind. When we realized we had missed the appointment, we called in to reschedule, and they told us that we couldn’t be seen there ever again.”

Jason couldn’t find any other dentist in the Upper Valley who would accept his NH State Medicaid. After looking around, Jason was referred to a pediatric dentist in Concord, New Hampshire. Jason traveled an hour and a half to get his daughter an exam, and then, a few weeks later, back for the surgery she needed. She needed a couple of teeth pulled, spacers put in, and caps on her molars. Jason feels lucky that the work was all covered by insurance. Still, “That’s a three hour trip. We were down there all day for the surgery, had to pull the rest of the kids out of school, so it’s definitely an inconvenience having to travel that far.”

Fortunately, Jason and his family have since found a dentist that accepts his insurance closer to home.

 

A Personal Story: No Phone, No Gas, No Dentist – Leslie, Lebanon

Thursday, March 29th, 2012

Leslie has spent 2 years out of work due to health issues and has been living on $500 a month for the past year. Nutritional deficiencies over the last few years have weakened her teeth so that now many of them have nerve damage and are falling out. She has no insurance for herself and so has been unable to address any of these issues. She has no income to cover the phone minutes to call dentists or the gas to drive to visit them in person.

A year and a half ago, Leslie’s daughter had an accident in school where she was hit in the face by a basketball and chipped her new adult tooth. Her daughter is covered by a dental insurance plan through her father, who lives further south in New Hampshire, as well as by Medicaid, but many of the prescriptions she needed for this accident weren’t covered and the root canal she needed meant that they still owed $450. “Even with insurance you can’t get in anywhere to get dental care…There are a couple of different children’s dentists around the Upper Valley but they aren’t taking new patients…” Or they don’t take Medicaid. Now her daughter needs orthodontia work, but she doesn’t have the money to start looking into addressing it.

Illustration by Dennis Pacheco.

A Personal Story: Family Access – Robin, Lebanon

Wednesday, March 28th, 2012

Robin is a 33 year old single mom who lives in Lebanon, New Hampshire. Robin and her children have New Hampshire state Medicaid insurance, which is limited in the dental care it covers for kids and does not meet Robin’s family’s needs. Robin’s eldest daughter just had three cavities filled, only two of which were covered by her insurance. It’s especially frustrating for Robin that her dentist claims her daughter is not taking care of her teeth, when, in reality, her daughter’s decay is due to medication she is taking. Robin has Crohn’s disease, and her daughter has irritable bowel syndrome, which will likely turn into Crohn’s. She explains: “I’m already facing probably getting dentures because I’ve been on my medication for Crohn’s for the last ten years … My kids do not do soda, they do not do candy, she’s gluten-free. It’s just the medication makes your teeth bad, so they’re soft, so she’s had to get a couple fillings. And they pretty much tell me it’s preventive care that I’m not doing correctly, and that’s not it at all. So they cover two cleanings a year and two fillings and that’s pretty much where it stops and they do not help with braces at all whatsoever. So she’s not getting braces because I can’t afford them.”

To make matters worse, Robin’s regular dentist has just informed her that he is no longer accepting Medicaid payments as of January of 2012. Robin’s family can still go, and her bill will be a sliding scale fee based on her income, but she doesn’t have the additional money in her budget right now, so she’ll be looking for a different provider.

Robin works with families who primarily have Medicaid as their insurance, so she knows how hard it is to find a dentist in her area who will accept Medicaid patients. A dentist in Vermont she regularly refers families to just told her he’s full and has met his quota for Medicaid patients. Some of the families she works with go to Concord, New Hampshire, for their dental care. “For some of these families that’s a big hardship because a couple of my families don’t have a vehicle … so it’s them trying to find a ride and then of course it’s during the day and then the kids lose out on a day of school.” Some of Robin’s families have had to make repeated trips to Concord, because a tooth wasn’t filled correctly the first time, and it was bothering the child, and they had to go back to get it fixed. “The parents that do have vehicles … it’s just extra gas money that they don’t have.”

Lack of access to affordable dental care is a problem for the adults as well as the kids. “It’s hard for the parents. Because a lot of them get disability or Medicaid and they don’t have the dental services … a lot of my parents are just literally pulling their teeth out and they’re just going without. One of my parents just did that because she can’t afford the dentures. Her teeth were really bad, and she just now is toothless and she just lives that way. It’s hard. It’s very hard.”

 

A Personal Story: It’s Been A Long Time – Linda, Plainfield

Monday, March 19th, 2012

Linda is 60 and lives in Plainfield, New Hampshire. She has been recently hospitalized with asthma and is having difficulty managing her condition. Linda doesn’t remember the last time she visited a dentist. “It’s been a long time.” Her health problems, being in and out of the hospital, have prevented her from seeing a dentist. She doesn’t know whether or not she needs any work done: “I have no idea.” She has Medicaid and Medicare, but doesn’t know whether or not they cover cleanings.

A Personal Story: A Year and a Half of Pain – Paula, South Royalton

Thursday, March 15th, 2012

When Paula moved to South Royalton, Vermont, because she had no job she was on Medicaid. She had a cap on her left rear molar which had cracked, but Medicaid did not cover any dental for her, even what seemed to her to be an emergency. She had to wait until she got a job, and then she had to wait nine months before the insurance kicked in to go get her tooth looked at. The first appointment was just an assessment, and she was referred to a different dentist where she had to wait again to get an appointment. “We were probably about a year and a half out where I was going with nothing on that tooth, dealing with the pain and the hot/cold sensitivity. When I finally got it taken care of by the dentist he said the gum was really worn down and damaged because it didn’t have the tooth protecting it and the surface there. So he actually had a difficult time and it was not the ideal crown that he put on…. It wasn’t a perfect fit.”

With the dental insurance from her new job, Paula could now afford dental care, but still found it difficult to get the care she needed because there were so few dentists, she still could not get on a regular six month schedule. It seemed like she could never schedule an appointment when she wasn’t working.

After she had her baby and wasn’t working, Paula called around to quite a few dentists because she was having pain in her lower left molar again. She found a dentist who was able to see her in the weeks before her insurance from her job ran out. Unfortunately, he ended up canceling the appointment, so although she got her teeth cleaned, Paula was not able to get her other concerns addressed. So now it’s been over a year since Paula has been to the dentist, she has no dental insurance and can’t afford to pay out of pocket.

A Personal Story: Kids Ok, What About Mom? – Lyza, White River Junction

Thursday, March 15th, 2012

Lyza, 27 years old with 4 kids, lives in White River Junction, Vermont, and she does not have a dentist that she sees regularly. The last time she was at the dentist was about eight months ago. At the time she had three teeth she needed to have pulled, and she used her annual allotment of money from Medicaid for that. Unfortunately, Lyza has significant work she still needs done: “I’ve got two front teeth that are broken and kind of chipping away.” Since it’s a new year, Lyza has money from Medicaid she can use for dental work, “But now trying to find a dentist that doesn’t just want to pull them out on me is a different story…. I asked [my dentist] if he could repair them, because they were just starting to get bad, but not as bad as they are now, and he didn’t really give me an answer…. He was just interested in yanking them out.”

Lyza’s kids have all been able to see the dentist and have their dental work completely covered by Medicaid. Even her six year old, who had extensive work he needed done at the hospital, was completely covered. “It’s just basically trying to find a dentist for myself that’s ridiculous. Because of my age, they won’t take me. And if it’s not my age, it’s my Medicaid.”

A Personal Story: I’d Like to Save Them – Patricia, Charlestown

Wednesday, November 2nd, 2011

Patricia, a 53-year old resident of Charlestown, New Hampshire, is disabled and lives on a fixed income. She had an accident in early 2011 that has necessitated major dental work which she can’t afford. In addition to breaking a tooth, she needs to address issues on other molars. Medicaid has offered to pull the broken tooth – they won’t cover caps or other work. But Patricia only has two molars left in her mouth.

She said “I’d like to save them, not lose them. If I have to keep pulling them out, eventually I’ll end up with dentures, which are also expensive and are not covered. They’ll pull them all out for you, but they won’t replace them!”

A Personal Story: All the Rest is Covered – Monica, Woodstock

Saturday, October 1st, 2011

I am a 57-year-old woman living in Vermont who had no dental work done for several years because I made sure my family was taken care of before myself. And when my husband passed away, I absolutely could not afford any dental care. It is very detrimental to my health. I have had severe infections and always been in the situation where I finally went to the dentist because there was nothing else that could be done. I was given antibiotics, which usually didn’t even help. I waited so long it was beyond what could be handled.

I was told several times that I could go in for a root canal and be able to make payments on it. I’d get halfway through and they would say: oh no we can’t take payments. It is a very sad situation. [Dental care] is very important to one’s health – one’s heart health – especially for a woman. It’s unfair and unconscionable that for myself – someone who is on state Medicaid – [dental care] is not included in my Medicaid bill. So I can go in and get all the rest of my body parts taken care of and looked at and yet the infections raging in my teeth have no importance whatsoever. I find that in this day and age it is ignorant to be holding people accountable for their health when you won’t cover the most integral parts that need to be checked.

A Personal Story: Delay Causes Cavities – Tessa, White River Junction

Sunday, September 25th, 2011

Tessa, who lives in White River Junction, Vermont, hadn’t been to the dentist in five years because her previous dentist had closed their practice and she didn’t know where else to go. Tessa’s mom helped her find a new dentist about six months ago. Although Tessa had never had a single cavity up until her last visit, “I had eight cavities and two root canals, because we went five or six years without going to the dentist. I had a lot of work to be done. And I had just been pregnant.” Fortunately the work was all paid for by Medicaid. “It was a new thing for me and it sucked, especially the root canals.” Tessa does not have an appointment to go back since her dentist’s office got washed out by the flooding [or Tropical Storm Irene], although she just found out he has a second office up in Barre.