Here is a shocker. The same preventative dental care procedure, deep cleaning or scaling that is covered under medicaid for children up to age 21 is not covered after age 21. According to V's dentist, the cost for this procedure is $1,000. Here you have a person who is unable to understand why they should tolerate uncomfortable and invasive work in their mouth, so they have to be under general anesthesia to get any dental work done, and because of the risks associated with general anesthesia they can only get this work done once every couple of years, so a deeper cleaning is necessary to prevent gum disease and tooth decay. This is especially true of an individual who does not have the motor skills to brush or floss their own teeth and will only hold their mouth open for someone else to do it for a limited amount of time.
According to Doral Dental, which is the dental insurance provided by state funded medicaid, the procedure is not covered for patients over 21 years of age, and there are no exceptions based on need. What if my daughter had no family who would foot the bill and was living in a group home? The insurance would rather pay for restorative work after the damage is done than to pay for the prevention?
I have contacted our resource coordinator to find out what options we have and found out that there is a fund for medical situations that insurance won't cover. She told me to fax and mail the invoice for the procedure to her and she would submit it to the committee for consideration. Hopefully the request will be approved. As a back up, I could request that funds from V's New Directions budget be re-directed from other services to this expense, but then she wouldn't have the money to receive the other services.
I don't understand why the same procedure would be covered for a child or teenager, but not for an adult. The need does not change or the benefit of the procedure, based on age. Here is another thing that needs to be addressed by health care reform.
According to Doral Dental, which is the dental insurance provided by state funded medicaid, the procedure is not covered for patients over 21 years of age, and there are no exceptions based on need. What if my daughter had no family who would foot the bill and was living in a group home? The insurance would rather pay for restorative work after the damage is done than to pay for the prevention?
I have contacted our resource coordinator to find out what options we have and found out that there is a fund for medical situations that insurance won't cover. She told me to fax and mail the invoice for the procedure to her and she would submit it to the committee for consideration. Hopefully the request will be approved. As a back up, I could request that funds from V's New Directions budget be re-directed from other services to this expense, but then she wouldn't have the money to receive the other services.
I don't understand why the same procedure would be covered for a child or teenager, but not for an adult. The need does not change or the benefit of the procedure, based on age. Here is another thing that needs to be addressed by health care reform.
