My Child's Dentist Failed to Inform

Get a second opinion about the condition of her mouth.

My guess is that he knew he wouldn't be paid much under Medicaid.

Consult a malpractice attorney. There may be something there. Bring your daughter. At 18, she's an adult and she will be the Plaintiff if it goes to suit.

Two possibilities:

1.) Dentist number 1 withheld information and did not do needed work for whatever reason
2.) Dentist number 2 is recommending unneeded work.

I agree with welkin (and that's not something that happens every day, or even every month). Get a second opinion.

Allison Powell said:

First of all, I feel I need to mention that my daughter has been on medicaid, so the coverage of service and the choice of dentists has been limited. With that being said, I had found what I thought to be a good dentist for her. I took her to him for years, up until he decided to retire due to Covid-19. All those years she saw him, he never told us of any extensive work that needed to be done on her. He always said she was fine at every check up. Then a year from seeing him last and finding another dentist, she all of a sudden has so much work that needs to be done that she is about to lose a lot of her teeth at 18! I don't understand why he would withhold information about the health of her mouth, but getting 13 cavities, and needing a tooth pulled, and needing root canals, crowns all within a year's time is unheard of. I feel that he never told us about any work needing to be done because medicaid wouldn't cover it, so therefore he would not get paid. It's not like my daughter doesn't try to take care of self by not brushing her teeth. This has to be an ongoing thing over years that built up into a terrible situation, not over just a year's time. Can I not hold him liable for neglect? If I had been told, I could have come up with a means of having her treated somehow.

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GET A SECOND OPINION.

I have had similar experiences with 2 different dentists.

The first time it happened, I was in college. I was skeptical when told I needed 8 fillings immediately, before the end of spring break, "It's obvious you haven't seen a dentist in a long time." I'd had a cleaning just 6 months before... just not at that office. I waited until summer, went to a different dentist, said nothing about the previous dentist. No cavities - not even the hint of one indicated on the x-rays - good thing I didn't subject myself to that unnecessary dental work.

The second time it happened, I was in my 30's. A real jerk. Same deal - even though I'd been getting regular dental care, with minimal work being necessary, he asserted that I needed massive amount of work. (And it was VERY obvious that my intake medical information hadn't been read either.) Refused to get any of the "urgent" work done. Again, when I went to another dentist, they found no such work necessary.

Either your daughter has had substandard care in the past, and that practice should be reported, or the current dentist wants to generate some extra cash (boat payment?) by performing unnecessary procedures, and should be reported.

Allison Powell said:

I feel that he never told us about any work needing to be done because medicaid wouldn't cover it, so therefore he would not get paid.

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That is not true. Medicaid does cover it.

Does Medicaid cover dental care?
Dental services are a required service for most Medicaid-eligible individuals under the age of 21, as a required component of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.

Individuals under Age 21
EPSDT is Medicaid's comprehensive child health program. The program's focus is on prevention, early diagnosis, and treatment of medical conditions. EPSDT is a mandatory service required to be provided under a state's Medicaid program.

Dental services must be provided at intervals that meet reasonable standards of dental practice, as determined by the state after consultation with recognized dental organizations involved in child health, and at such other intervals, as indicated by medical necessity, to determine the existence of a suspected illness or condition. Services must include at a minimum, relief of pain and infections, restoration of teeth and maintenance of dental health. Dental services may not be limited to emergency services for EPSDT recipients.

Oral screening may be part of a physical exam, but does not substitute for a dental examination performed by a dentist as a result of a direct referral to a dentist. A direct dental referral is required for every child in accordance with the periodicity schedule set by the state. The Centers for Medicare & Medicaid Services does not further define what specific dental services must be provided, however, EPSDT requires that all services coverable under the Medicaid program must be provided to EPSDT recipients if determined to be medically necessary. Under the Medicaid program, the state determines medical necessity.

If a condition requiring treatment is discovered during a screening, the state must provide the necessary services to treat that condition, whether or not such services are included in the state's Medicaid plan.

Does Medicaid cover dental care?

Your premise that the dentist wouldn't get paid doesn't make sense. Either Medicaid or you would pay.

In all fairness, Medicaid and Medicare DO pay health care providers SOMETHING.

However, that SOMETHING is far less than what private insurers pay for the same service.

The rate at which Medicare reimburses health care providers is generally less than the amount billed or the amount that a private insurance company might pay. According to the Centers for Medicare & Medicaid Services (CMS), Medicare's reimbursement rate on average is roughly 80 percent of the total bill.

Not all types of health care providers are reimbursed at the same rate. For example, clinical nurse specialists are reimbursed at 85% for most services, while clinical social workers receive 75%.

Medicare Reimbursement Rates and Payment Schedule Explained

Medicaid reimburses providers on an even more discounted scale than does Medicare.

The good news is she is old enough to join the military. She could enlist in the military and get her dental treatment done for free. Only in the U.S. can one get a career and get medical issues taken care of. What a great day

Disabled Vet said:

The good news is she is old enough to join the military. She could enlist in the military and get her dental treatment done for free. Only in the U.S. can one get a career and get medical issues taken care of. What a great day

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Les États-Unis d'Amérique sont le plus grand pays de la planète !


Je me sens très français aujourd'hui !

Disabled Vet said:

The good news is she is old enough to join the military. She could enlist in the military and get her dental treatment done for free. Only in the U.S. can one get a career and get medical issues taken care of. What a great day

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I am not sure if that's still the case. If she actually has severe dental issues, she might be ineligible for enlistment.

Not everyone is medically eligible. My parents are both veterans, and stayed healthy until their late 80s, but they both have a genetic disorder that is is now considered disqualifying for enlistment.