Thursday, September 25, 2014

Worried for my Teeth

I get my new Medicare Advantage plan packet, which is thicker than War and Peace and comes like clockwork every year.  It's more boring than War and Peace, so you have to be very very bored to read any of it.  As if it is not enough to get the one inch thick booklet from the Medicare Advantage plan I'm in, I'll probably also get one from Medicare too.

I'm confounded and confused by the layers in medical insurance.  I'm on medicare, but to get medicare I have to have a medicare Advantage plan through a private source.  In my case, it's Samaritan health.  They have a local monopoly, from the mountains to the coast and claim nonprofit status.

Since I fall way below federal poverty guidelines, I have medicaid as secondary insurance.  Medicaid is state run and in Oregon, it is called the Oregon Health Plan.  But there are different plans even under that.  Then you have to join an HMO, privately run, to get OHP.  I hope I am confusing you.  I don't know for sure that this is all accurate, but it is what I think is the big picture of the layers.

Here, where I live, the OHP HMO is owned and operated by the local health care monopoly that owns the hospitals and doctors from the mountains to the coast.  Your doctor works for your insurance company.  This seems like a basic conflict of interest.  Back to the point.....

I have no choices even though the monopoly will claim I do.  To get OHP as secondary, I have to use IHN as the OHP HMO.   It's the only local HMO providing care through OHP.  Since my primary insurance is medicare, technically I would have a choice, but I don't, unless I want to drop having a secondary insurance.  No getting IHN without signing on to a Medicare Advantage plan owned by the monopoly.

Now we have another layer, called a CCO or Community Care Organization.  These were created regionally by Oregon to save costs on health care, through preventative and wellness programs theoretically.   They get a set amount of money to cover the number of people in the CCO.  Total money the state gets for medicaid or...ok, I'm fuzzy here, but the gist I think is total state money combined with federal gets divied up between the state CCO's, who use it, and when its gone its gone, for that year.  So they better use it wisely.  Something like that.  I'm hazy on it.  I have no clue about these layers.  Nobody knows anything and its just a whole lot of awful.

I have a nurse practioner as PCP at a health clinic and it can take twenty minutes on hold to try to get an appointment a month from now.  A month from now anything wrong this minute will be much worse or resolved.     So it's kind of funny all around.

My Medicare and medicaid have been dumped into the CCO, still through a medicare Advantage plan and OHP HMO IHN.  But it's called a CCO now and it's supposed to be all inclusive, include physical, mental, dental and what not care.  Nice, right?

Except it isn't.   It's even more bungled and confused than ever.   Need information?  Good luck!

My shiny new inch thick plan specifics epic novel arrived in the mail and I began leafing through it, for no good reason, while drinking my morning coffee.

I go right to the comics section, oops, I mean annual notice of change in plan page.  This is the kick you in the gut page.  Or the You've Won! page.

  On page seven of the Annual Notice of Changes for 2015 I find this and my stomach goes all lurchy:

You may not be able to read this, as its blurry.  On the left it says Preventive Dental Services.  These are exams, extractions, teeth cleaning and fillings.  All else covered was dumped long ago.  Things like crowns.  Except pregnant women and kids can get them.  Even illegal immigrant pregnant women, I'm told.  I wonder if that's true.

On the right there are two columns.  One reads 2014 (this year) and the other 2015 (next year).  Under 2014 (this year), it reads:  Preventive Dental Services are covered.  Under 2015 (next year), it reads: Preventive Dental Services are not covered.

OMG.  No more dental coverage.  At all.  Not even for extractions.  It says emergency dental procedures might be covered if a person is in the hospital.

Here's the thing.  People way way down under the poverty level cannot pay for dental work out of pocket.  It's impossible because it costs too much.  There's nothing a person on SSI can do to save enough money to get that done, even if you saved every penny you got and didn't pay anything out for rent or utilities or food or washing your undies, and hid it all away in a hole, then dug it up to present to the dental receptionist, it's still not enough money.  It's just the way it is, too great a disparity between what is charged and what a person on disability gets.

I'm not saying we should get free extractions and fillings.  I'm saying there needs be an option, like affordable dental care, so we could save up and pay, but there's nothing out there now like that because dental care costs is beyond affordable to pay completely out of pocket for people in low brackets and for many people in middle income brackets.

 So I'm saying Oregon should reduce standard of care, to lower costs, so people can have an option to take care of their teeth.  Like let techs pull and fill teeth.  Something like that.  Otherwise, an entire population is locked out of any options and faces the future full of mouth misery.   We all get old and our teeth break and fillings fall out and we get cavities.  Poor people are no different.  That happens to us too.

I'm sad.  I like my teeth.  But I don't have the money and I never will have the money to pay out to get Xrays, cleaning, exams, fillings and extractions.  One appointment would wipe me out.

I have coverage a few more months.  I wonder if I should try to get all my teeth pulled now, to reduce the suffering I will have until I die with mouth issues.  I think it could be called a medical necessity, if all coverage for even the smallest dental care ends in three months.  There are no other options out there.

Already, vision exams and eye care have been axed from coverage.  Not just your copay has gone up--axed from coverage.  Hearing exams also.

These things are all important in preventing further health problems.  Dental care might be the MOST important preventative care.  I say that because I see what bad teeth does to cats.  I say it from experience that life is hell when your teeth hurt.   Your world becomes that pain.  Think you concentrate on a good diet, when you can't eat without pain?  Just saying, dental care is frontline in keeping your health good.  So all this CCO wellness preventive care bullshit is just bullshit.  In my opinion.

We need an option.

Sure, I suppose maybe back alley dental clinics will arise, some guy with a chair, pliers and straps will pull your tooth for $30, no questions asked, on either side.  In Oregon, that's a crime, called "practicing medicine without a license" and it applies to you, yourself, too, if you pull your own tooth.  You could be arrested.  They got you wrapped up between that rock and hard place here.


Not asking for free dental extractions and fillings.  I'm saying we need an affordable way to get these things, pay for them, and there won't be one in three months, when the CCO stops covering dental care and with the unspeakable cost of dental care, so that most could never in their dreams pay for it out of pocket.

I'm saying, Oregon, time to let technicians pull and fill teeth, to lower costs, so I can pay to care for my teeth.

I think somewhere out there may be cheaper dentists, solo acts, not bought and sold by a big corporate owner.  After all, the price for cat dentals can vary depending on the dentist by hundreds of dollars.  So, my guess is, out there somewhere, are cheaper more affordable dentists for people too. 

9 comments :

  1. Sigh. Our medicare system has flaws but is pretty good. EXCEPT that dentistry isn't covered. And costs several arms and legs. There are places which will help - but the waiting list is a couple of years. But which time the problem is huge or has gone away.
    Hiss and bloody spit.

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  2. You have free health care for everyone there, right EC? But it doesn't include any sort of dental coverage?

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  3. You've got it. None. Health care isn't quite free though. A levy is taken from tax payers and depending on your income you pay a bit at the doctors too. Hospitals as a public patient are free. Prescriptions you pay for, but low income earners pay a lot less. I think it is around $6 a script, with an annual limit. Once you have reached the limit you pay nothing.
    Mind you, our current Government is trying to tinker with it - and everyone will pay more. Quite a bit more if they get their way.

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  4. Is it really expensive there also, dental care that is? For example, what is the cost of a dental exam with X-rays? Would like to compare costs, out of curiosity I guess. But, to get a baseline, how much would you pay for a cup of coffee (or tea) at a restaurant there, an everyday people type place?

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  5. I had a dental examination last week - no x-ray. $77. X-rays would have doubled it. I have private insurance (which I need) and got back nearly $24. A rip off. A cup of tea in a cafe is around $3.50 - and more in restaurants. I hardly ever buy them.

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  6. Hmmm, ok that comparison all fell apart when I realized I have not bought a cup of coffee in a restaurant forever and a day. I don't know how much that costs here. Was looking online for average dental exam plus Xray costs here and found sites that said anywhere from $100 to $350. That insurance sounds almost like more trouble than its worth, although it paid a third the cost, sounds like.

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  7. The price depends a lot on how many Xrays. Filling prices depend on how large, how many surfaces the filling is and what type of material is used to fill the tooth and the clinic. I got an appointment for exam and cleaning at my own dentist, just in case this is my last time there, and I'll ask what prices are if I had no insurance at all, which sounds like I won't in three months. I first got all my teeth fixed a year ago, during the summer, and I felt like a million bucks. I got a bad one pulled, too. So soon it may be over, makes me sad, but at least I got them all fixed once!

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  8. You can get Medicare without an Advantage Plan (or else a supplement plan, which is what I have), but you need one of the other in order to get the maximum benefit.

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  9. I'm too under on money Snow, so I qualify for Medicaid to help with copay on medicare, something that dumped me into the CCO. Owned and run by The monopoly. I can't use the secondary medicaid without also signing up for their version of medicare, too, at its most basic, so when there are large copays, IHN takes it up. OR did. As now its all one, the CCO.

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