Odds & ends

On the tree outside my window is a gray squirrel basking in the sun. The temperature is only in the mid-30s, with a slight breeze. For a while the squirrel was stretched out flat against the tree limb, eyes closed, as if trying to expose as much of its surface to the sun's light and warmth as it possibly could. Now it's moving around again, thinking there must be some more efficient method of getting comfortable.

In tooth-related news: I have finally graduated to chewing whole (canned) beans. I also bought some kiwi fruit yesterday in hopes they'd be soft enough to eat, though I haven't tried one yet. At the store some chicken nuggets were tempting me to buy them, reminding me that they were processed enough not to be terribly chewy, but in the end I decided to let chicken-related foods wait till another day.

Been looking more at Maryland's medical assistance-related information, and becoming more convinced that there must be some way to get them to pay for treatment of a genuine health problem, even if it does involve my mouth. Though adult preventive dental care is certainly not covered, an online list of services provided lists "Physician services including a dentist’s medical and surgical services" which sounds like it should cover my problems. Unfortunately, a lot of the info I keep finding is outdated (some pages and files were last updated in 2002). To do tomorrow as early as I can manage it: Call one or more of those Medicaid-related phone numbers and find somebody who has current information.

Yesterday at the library I spent some time looking at a textbook for dental hygienists and reading descriptions of nasty things that can go wrong in your mouth. I know what you're thinking, but I did not end up convinced that I had a dozen different incurable diseases; in fact, looking at the photos reminded me that there are worse things that can happen. Am still scared of losing my teeth, mind you, just not as freaked out about my own problems as I was before.

Last book read: The Boy Who Drew Cats and Other Japanese Fairy Tales. Thin book--I gobbled it all up this morning like a box of chocolates. Next book on the pile to be read: C.J. Cherryh, Forge of Heaven. It gets some seriously mixed reviews from fans, but even Cherryh's slower passages usually interest me. After that, I may switch back to non-fiction for a while, though I haven't decided what topics I want to read about yet. Nothing related to teeth, though.

How Md. Medicaid Saved Millions

In case anyone's wondering why I keep trying to figure out how to get dental care when I already know about the local dental school and, gosh, maybe I should be satisfied that that's the best I can do:

Maryland Medicaid saved millions of dollars by ending reimbursement of dentists for treating adult dental emergencies

The Maryland Medicaid program eliminated reimbursement to dentists, but not to physicians or hospitals, for treating adult dental emergencies in 1993. By 1995, 2 years after this change in reimbursement, Medicaid costs for adult dental care claims plunged to zero from more than $7.5 million in the 2 years preceding the change. Medicaid reimbursement for routine adult dental services was eliminated by the State in 1976.

Surprisingly, Medicaid costs for emergency dental care for adults also dropped significantly in every other care setting, generating an additional $232,470 savings during the post-change period (1993-1995). For instance, emergency department (ED) costs for dental emergencies dropped 10 percent from $723,835 to $651,649, even though the number of ED claims rose from 2,081 in the pre-change period to 2,245 in the post-change period. The largest drop in costs was seen in physician-linked ED claims, which dropped nearly 69 percent from the pre-change to the post-change phase. Thus, Medicaid's goal to reduce dental costs was achieved but perhaps at a price, suggests Richard J. Manski, D.D.S., M.B.A., Ph.D., Dental Scholar-in-Residence at the Agency for Healthcare Research and Quality.

Dr. Manski and his colleagues point out that disadvantaged patients may have been confused by the policy change, perhaps believing that Medicaid would not cover any care for dental emergencies. They likely suffered poorer health outcomes and paid for emergency dental treatment out of pocket, found free clinics, or received free care from generous dentists. These findings are based on analysis of Maryland Medicaid data on ED and other provider claims by adult Medicaid patients for the treatment of mouth pain and infections associated with the teeth and periodontal tissues during the 4-year period from February 16, 1991 to February 15, 1995.

Disadvantaged patients may have been confused? How about everyone I've spoken to at social services, the county health department, the state dental association, the hospital emergency room, my primary care provider's office, and every other place I have been to or called up in the last few weeks? If Medicaid patients are supposed to be able to get "treatment of mouth pain and infections associated with the teeth and periodontal tissues" why is it that nobody has told me how?! The only advice I have managed to get from any of these people who should know has been along the lines of "pa[ying] for emergency dental treatment out of pocket, f[inding] free clinics, or receiv[ing] free care from generous dentists." Is anyone really surprised that patients might be confused?

Have I mentioned lately how much I hate bureaucracy? 'Cos I really, really hate bureaucracy.