Dental care for a person with a developmental disability can both ineffective and a nightmare without the use of anesthesia. This is an important issue and needs to be addressed.
"Dentists want insurers to pay for anesthesia for patients with special needs
Published: Friday, June 17, 2011, 6:22 PM
By DAVID WENNER, The Patriot-News
Dr. Dennis Charlton, Pennsylvania Dental Association president, speaks at a gathering of PDA members at the Capitol Rotunda on June 14. 06/14/2011 DAN GLEITER, The Patriot-News
Autism can cause a mouthful of pain, and worse. That’s why Pennsylvania dentists want a state mandate to require health insurers to pay for general anesthesia for patients with mental disabilities that prevent them from tolerating dental work while awake.
The mandate is contained in a bill sponsored by state Rep. Stan Saylor, R-York.
It would apply to all children 7 or younger, and to older people with conditions, such as autism, Down syndrome or developmental disability, who otherwise wouldn’t be able to undergo dental work.
One advocate for such patients is Dr. Bill Spruill, a Carlisle dentist. Spruill is a former president of the Pennsylvania Dental Association, which has pushed for the mandate for years. “This is a small group of patients, with critical needs, who can’t be treated in a regular dental setting,” he said.
Without it, it’s impossible for them to undergo dental work or, for some, to even receive preventive care such as an exam and cleaning. Typically, these patients experience fear, extreme anxiety or agitation that can’t be overcome with standard pain- or anxiety-control measures available to dentists.
Spruill argues that denial of anesthesia, which can cost from $500 in an outpatient facility to $3,000 in a hospital, amounts of denial of medial care, since many patients can’t afford to pay for anesthesia on their own, and thus go without the dental care.
Spruill said that, in 31 years as a dentist, a health insurer has rarely, if ever, paid for general anesthesia for one of his patients.
However, the medical director for a local health insurer, Highmark Blue Shield, said Highmark does pay for general anesthesia for some dental patients.
Those include patients with disabilities that warrant them being under general anesthesia for the dental work, as well as others with extreme anxiety or sensitivity to pain, or dementia, said Dr. Andrew Bloschichak, the senior medical director for Highmark.
He said Highmark pays for general anesthesia when it’s deemed medically necessary. But it has “no blanket policy” regarding the coverage, he said."
