Kids on medicaid less likely to get treated for dental procedures

Katherine - posted on 05/24/2011 ( 13 moms have responded )




And the SOURCE:

Any number of studies have shown that kids who have bad oral health don’t do as well in school as their peers with healthy teeth. It stands to reason, too. Rotten teeth hurt. And when you’re in pain, it’s hard to concentrate — or care or learn — about much of anything.

Kids in families with decent health insurance don’t have to endure toothaches for long. They can fairly easily get a problem taken care of, return to school and to learning. But kids on Medicaid and the Children’s Health Insurance Program (CHIP) — both forms of health insurance, by the way! — don’t have it so good.

A study published in the most recent issue of Pediatrics found that dentists frequently denied appointments to kids who were covered by these plans.

The Los Angeles Times reports that researchers led by Joanna Bisgaier from the University of Pennsylvania had six women pretend their 10-year-old son had fallen from his bike and chipped his front tooth. These women called around to 85 dentists in Cook County, Illinois, around half of whom listed that they participated in Medicaid and accepted Medicaid insurance.

Each office was called twice — once saying that they were on Medicaid, the other time saying they were covered by Blue Cross. Only 36.5 percent of the Medicaid calls ended with an appointment, whereas 95.4 percent of the Blue Cross ones did.

The Medicaid moms were overall 38 times more likely to be rejected by dentists who didn’t participate in the program, but still 18 times more likely to be denied an appointment even by those who were listed as participants in Medicaid.

The Times lists some of the reasons dentists reported for turning away Medicaid clients:

“[L]ow fees, less patient compliance, negative attitudes toward beneficiaries, and administrative requirements being too burdensome. There also is literature on dentists’ unwillingness to treat certain populations, including young children, patients with developmental disabilities, and patients living with HIV/AIDS.

What can possibly be done about this? Should a child with a chipped front tooth have to live with it just because his parents aren’t on a private dental plan?

I chipped a front tooth when I was a little older than 10. It was not only physically painful, it was emotionally off the charts. Of course this was a hundred years ago and I only had to go to school one day before I got an appointment and we had fancy insurance. But the only thing I thought about during that toothless day was my toothless smile. I’m surprised I even agreed to go to school. I’m not sure what school life would be like with a broken smile long-term. It’s clear to me that my the status of my oral health impacted learning.

No wonder people with private health insurance are scared to let the uninsured get the same benefits as they have if getting an appointment is at the whim of whatever off-the-record policy has been set at dentist and doctor’s offices. Or maybe the flip side: we should all have the same kind of insurance so we can’t be discriminated against — are my kids marvelously insured teeth really more important than the kid’s down the street?

This is ridiculous. Just goes to show that people on medicaid ARE treated differently in every aspect. Including maternal care, including GP care and other care. I know the study was done on dental but I have medicaid and when I had my 2nd daughter the difference was appalling as opposed to when I had private insurance with my first.


Amber - posted on 05/26/2011




I think I can shed some light on this for you. As many of you know my SO is in the medical field and is finished with med school, just have to finish clinicals now. He's been a NP and for almost a decade and this is how he has explained it.

Many private doctors do not accept medicaid because the government pays 10-15 CENTS for every dollar billed. That is an incredibly small percentage and does not even cover the cost of seeing the patient.

Doctors have to pay lease payments, malpractice insurance (they need multi-million dollar coverage), nurses, secretaries, utilities, office supplies, equipment, medical school bills, regular license renewals, continuing educational classes every year, and a multitude of other payments.

Unfortunately medicine is still a business.and doctors have to be bringing in enough money to cover the bills. No person can afford to charge less than their bills. Even with negotiated discounts, private insurance companies cover at least 50% of the bill. The government doesn't even pay half of that.

This would also be the reason why many people are having problems finding a regular doctor. It takes the same amount of time to specialize and be guaranteed a check without the monthly liabilities.

Medic - posted on 05/24/2011




My kids have both been on medicaid at one time or another and I have never had problems getting them seen or treated. I guess sometimes it comes down to what the parents know about their rights and whatnot.

[deleted account]

It is one thing if a practitioner states up front that they do not accept Medicaid, but it would really upset me if they said they did, then denied the appointment.
I do understand why some do not accept Medicaid: Medicaid pays less than half of the standard fees for procedures, so often the practitioner makes absolutely no profit on those clients--it is pure charity--and many smaller practices simply cannot afford to accept many of them. Another reason is the extensive paperwork--it takes a lot of time, thus a lot of hourly wages, to fill it all out, then half the time (literally HALF) they find some piddly little error that is common sense to fix and deny the claim. The recipient doesn't hear about it, but the practitioner doesn't get paid, or has to re-do a ton of paperwork.

A simple fix would be to provide everyone with the same insurance and streamline the payment policy. If everyone was using the same insurance and pay methods, we could cut costs and error margins dramatically.....but that's just too simple for the US.


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WENDY - posted on 08/06/2011




i have private insurance for my daugter ad my self.. it cost $115 a week, that's $6000 a year. i'm pretty sure she going to need some teeth fixed unfortantly my dental max out is $1000 on her, i'm pretty sure it's going to cost me around $2000 out of pocket, which i'll have to put on my credit card and pay 14% intrest, forever on.. did i mention i'm still paying off her delivery bill which was $3800 after my private insurance paid.. i wish i had medicaid. i find it just ridiculous i have to be in mega debt just to have health insurance, while others get everything completly paid for.. i agree we should all have the same insurance and coverages.. as well as the same co-pay's, max outs and premiums.

Dana - posted on 05/25/2011




That's not necessarily the case though Emma. They do have insurance, it's just paid for by the state. It's still a regular insurance company that backs it. So, those on medicaid don't have to worry about a damn thing. Doctors know this and are more apt to order tests because their money is guaranteed to come in.

Stifler's - posted on 05/24/2011




The dentist probably gets more money out of people with private health. I know since I got private health I've been more inclined to be like "yeah do those x-rays and whatever else and do a clean and numb my sensitive teeth" whereas before when I was a kid my parents would only get the bare minimum done like any fillings etc. when they were paying with no insurance.

[deleted account]

Never had any problems w/ any medical/dental care for any of my kids.... or myself (except when I had private cuz the stupid insurance company LIED to me).

We do have waitlists on some things (nothing we've ever needed), but we also don't have a lot of specialists on island so regardless of your insurance you will have problems w/ certain things.

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btw, I am NOT saying it is fair that Medicaid recipients have limited access, just that I understand why it happens. Sometimes understanding the "why" behind certain issues can help in finding better solutions.

[deleted account]

That is true, Dana, but even with negotiated reductions, insurance companies still pay more than Medicaid in most cases. I used to know the average, I think it was something like 30% more, but I'm not sure anymore.

My blood work, for example, I have a test done every 6 weeks that costs me $89 because I cannot get insurance due to pre-existing conditions, when I had access to group insurance, the insurance company paid $42 for the same test, it was covered at 100%, so the practitioner only got $42. Medicaid pays $24 for the same test, again, no co-pay, so the practitioner only gets $24. The practitioner makes nothing when he does that test for Medicaid recipients, so he can only take a few of them at a time to leave room for jobs that actually pay his bills.

Katherine - posted on 05/24/2011




See with medicaid there is no co-pay either. NONE. I don't know if that has anything to do with it. It IS a TON of paperwork, I know that.

Dana - posted on 05/24/2011




But, Kelly, private insurance negotiates the price for procedures WAY down. Say a surgery I have with no insurance costs me $10,000 but, if I had insurance they would negotiate it down to $3,000.
So really it's no different, in the end they're all backed by some insurance company that negotiates the price.

[deleted account]

Dana, Medicaid does always pay (if you fight the paperwork hard enough), but they pay a much smaller amount for the procedure. So, for example, if 2 patients come in for the same thing, one having traditional insurance with a 20% copay, and one having medicaid, even if the one with the 20% copay never pays his 20%, the practitioner will still get paid more for the procedure done on that patient than for the one done on the Medicaid patient.

Dana - posted on 05/24/2011




That's interesting when it's usually the complete opposite. Medicaid patients bills are ALWAYS paid (by the state) where as, private insurance bills aren't always paid. Yes, the insurance company pays their portion but, do the actual patients pay their portion - not always.

Not to mention that EVERYTHING is covered under medicaid where as with private insurance, you have to fight tooth and nail to have procedures covered.

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