Posts Tagged ‘Dental treatment’

They Get You by the Teeth

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January 22nd, 2012

Lack of dental coverage sends patients running to ER for pain relief

While government-managed health care programs such as Medicaid pay for emergency room visits for adults seeking temporary relief from toothaches and other dental emergencies, coverage of outpatient dentist office treatment for those problems varies from state to state, according to a 2011 federal Medicaid report. Federally mandated preventive and other dental care usually ends when Medicaid recipients enter early adulthood. That leaves states to determine whether they will provide dental benefits to adult Medicaid patients and if so, what type and how much.

No Medicaid

The report shows that 10 states offer no Medicaid dental benefits to adults. The remaining states offer a jumble of services that leave many adults with inadequate and limited access to dental care. In addition, Medicare doesn’t cover routine dental care or most dental procedures such as cleanings, fillings, tooth extractions or dentures, Medicare spokeswoman Ellen Griffith said. As a result, many adult government health care program enrollees and uninsured Americans are turning to emergency care providers nationwide to manage the pain from dental problems. Unlike dentists or oral surgeons, ER doctors and other health care providers can’t pull a tooth or treat other dental problems.

The ER

One dentist estimates as many as 40% of the patients she sees needing an extraction had previously sought care in an ER. Those ER visits translate into higher costs for taxpayers as many patients return to the ER two or more times per dental problem to manage symptoms, according to the ADA. And, while the Affordable Care Act addresses dental care for children on Medicaid, the requirement doesn’t exist for adults, ADA spokesman Robert Raible said. "This funnels everyone to the ER, which is the most expensive place to get health care," said Sorkey.

Dental emergencies

Between 1.3% and 2.7% of all ER visits nationwide that don’t result in a hospital admission are dental emergencies, the HRSA report says. A 2011 South Carolina Dental Association study estimated a single ER visit for toothache pain resulted in a Medicaid reimbursement of $236. The report found a dentist’s office visit, which would include extraction of an infected tooth, would be about $107. "The key thing is the problem is not solved when they go to the emergency room," said Phil Latham, the Association’s executive director. "If they can go to a dental office, the problem is solved for half of the reimbursement."

The ADA

To better evaluate the impact of using the ER for relief of dental emergencies nationwide, the ADA is working with the Centers for Disease Control and Prevention to devise a methodology to get "broader and deeper numbers and look at key indicators for solutions," ADA President William Calnon said. Louisiana Medicaid Medical Director Rodney Wise said the state’s decision not to cover dental expenses for most Medicaid patients 21 and older is about money. South Carolina and Washington State cut adult Medicaid dental benefits last year, and other states, such as California, have reduced benefits in recent years in an effort meet budget cuts, according to state and federal reports.

Tags: Dental treatment, Medicaid, Tooth extractions
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