Family struggles to find needed dental care
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David Shetler of Milton has heart problems and needs oral surgery, but he’s on Medicare and can;t find a clinic that will accept him or that he can afford. His wife, Alice, has been calling oral surgeons throughout southern Wisconsin and northern Illinois for months with little luck, but is hoping her efforts will bring more awareness of the gap left in services because Medicare doesn’t cover dental issues.
JANESVILLE — Alice Shetler is on what she considers a life-saving mission.
The latest in a series of challenges for her family is finding an oral surgeon to remove her husband David’s infected teeth.
The situation is critical because David is on a pacemaker and has heart problems. Infected teeth can lead to heart problems, she said.
“Well, he already has heart problems,” she said.
David is on Medicare, though, leaving the family with few affordable options for the procedure.
It’s a problem many Americans face because Medicare doesn’t cover dental care, and people on Medicaid have a limited number of dentists who will accept them.
“There truly is a gap,” said Terri Pass, elderly benefits specialist with the Rock County Council on Aging.
“It’s a huge problem,” said local dentist Mark Karrels, president of the Rock County Dental Society.
Alice has been talking to oral surgeons around southern Wisconsin and northern Illinois for months with little luck. Clinics she’s found have waiting lists or wouldn’t accept her husband because of his other health issues.
“I’ve called everywhere,” she said. “We just don’t know where to go or what to do.”
One surgeon asked for $2,500 up front, something the Shetlers don’t have.
David, 46, had his first of three heart attacks at age 40. His health forced him to end his trucking business, and his only income now is Social Security disability. The family lost their home and vehicles; Alice recently lost her job, and they now live with family.
They say they’re finding out firsthand how much health care reform is needed.
“Medicare should include dental. … They just don’t cover it. Period,” Alice said.
Going to the HealthNet of Janesville free dental clinic isn’t an option because it accepts only low-income, uninsured patients, and Medicare counts as “insurance,” even though it doesn’t cover dental.
“The main reason we don’t move in that direction at this point is we’re not set up to bill the federal government for individuals on Medicare and Medicaid,” executive director Traci Rogers said.
Not to mention the clinic wouldn’t be able to financially support extra staffing and equipment, she said.
“Right now, we’re scheduling at least three months in advance for dental appointments,” she said.
HealthNet tries to bridge as many gaps as possible without duplicating services, she said, so she refers patients on Medicare to clinics in Beloit, Madison and Rockford, Ill., equipped to bill the government.
Karrels receives about a dozen calls a day from people on medical assistance, but he said dentists just can’t accept everyone. The crux of the problem is the reimbursement rate is so low, he said.
“We treat patients referred by social agencies or by case workers on a case-by-case basis,” he said. “We have to, quite honestly, be selective.”
The Wisconsin Dental Association has lobbied legislators to raise the reimbursement rate so more dentists would accept more patients, he said.
More than 520 of the association’s dentists do provide free services to pre-qualified patients through its Donated Dental Services program, he said. For more information, visit www.wda.org.
“Overall, charity is not a workable solution to this problem,” he said.
The only dental school in the state—Marquette University’s School of Dentistry—does offer reduced-rate services and accepts Medicaid, said Dr. Timothy Creamer, associate dean for clinical affairs.
“We have to break even,” he said.
Patients must be screened, and a waiting list typically exists, he said.
Alice hopes by sharing her family story, someone can help find solutions to their problem, because she knows her family isn’t alone.
“I’m just hoping getting this out there, somebody might know something,” she said.
