Going to the Dentist

Some dentists say they can’t afford to provide care for patients on government programs. Minnesota is among the states with the lowest reimbursement rates (currently 27 percent). Minnesota Public Radio, May 2, 2017

I never would have suspected that one of the most hurtful episodes of our son’s mental illness would involve our family’s dental office. Roger and I had trucked our kids back and forth there all their lives. Cleanings, braces, a few fillings, wisdom teeth, the whole nine yards.  It was a part of the routine undercurrent of our lives that we all took for granted.

Until we received a letter from our insurance company saying Jim was ineligible for our family dental plan. A sharp pain zapped through my stomach. I should have expected this. He was an adult and no longer a student, but still it felt as if our family was being delivered another blow. I set the letter aside and poured myself a glass of sun tea. After I added a slice of lemon, I picked up the letter and reread it.

I knew many dentists didn’t accept MA, Medical Assistance, Minnesota’s name for Medicaid, government health insurance for poor people. Jim’s insurance now that his schizophrenia had eclipsed our family budget. I remembered a meeting last year at the local library. Sitting at a long table amid stacks of books and rows of computers, local dentists had lobbied me, their state representative, for better funding. They were reimbursed a quarter of their costs by MA compared to regular insurance. Only one of the dentists accepted it.

I finished my tea, swallowed hard and called our dental office. I wanted to spare Jim the hurt of being turned away, to run interference for my adult son as if he were still 10. “I’d like to make an appointment for my son. Do you take MA?”

“Sorry, no,” she replied in a matter-of-fact tone, not missing a beat. I heard another phone ring and a woman’s voice answered in the same tone.

 “I know you don’t make the policies, but he’s been coming here since he was a little boy,” I replied, forcing my voice to be nice.

“I’m afraid I can’t help you,” she repeated, as if reporting her store was out of potatoes. “Sorry.”

Sorry had become an ugly word everybody else got to say, and then they were done. The phone felt heavy as I put it back in its cradle.

A few weeks later, when I got home from the Capitol and pressed the answering machine button, I was surprised to hear, “This is Metro Dental. Jim’s overdue for his checkup.” I closed the refrigerator door where I was surveying leftovers in hopes of finding something to nuke for dinner. Shoving aside my folders and purse on the counter, I picked up the phone and dialed forcefully.

“I’m confused. Your office wouldn’t schedule my son’s checkup because his insurance is MA, but we just got a reminder call.” I tapped my fingers on the counter.

“We do accept it,” the receptionist replied, sounding surprised. “Would you like to schedule?”

“As soon as possible.” Before they changed their mind.  Finding another dentist hadn’t yet risen to the top of my pile. 

Jim and I arrived promptly on the appointed day. We sat in the usual green chairs, in the familiar waiting room that smelled like Novocain. The room where Angela and Jim used to put puzzles together and I read books to them about dogs. I didn’t like this office anymore. Maybe next time they wouldn’t take Jim. We’ve had enough upheaval in our lives without this.

“Jim Greiling.” 

Jim followed a smiling young assistant through the door he’d entered for more than three decades. His head was up, looking the assistant in the eye, with a slight smile. Not staring at the ground or gazing blankly into space with that dazed, achingly sad look he had lately.

I picked up a “Family Circle” and roughly leafed through it — all my mind could concentrate on. Before I settled on an article, they were back.

Jim looked stricken, as if he’d been cut from a team.

“We can’t see him,” the young lady said to me, somewhat apologetically. “He doesn’t have insurance.”

“He has MA. I specifically asked if you accepted it.” I felt like a dragon spewing flames.

“Sorry.” She nervously thrust a sheet of white paper at me. A list of places that took MA. Union Gospel Mission caught my eye. I drove by it often. It was near the Capitol. Never had I thought our Jim would be queuing up there with homeless people. 

“Let’s go, Mom,” Jim interjected in a weary voice, his head tucked into slumped shoulders. 

My protest died in my throat, and I felt humiliated, like him. Other patients looked at us, probably wanting peace in the waiting room. After the thousands of dollars our family had sunk into Metro Dental Care, we were being given the bum’s rush. And I knew it was perfectly legal.

Unbelievably, a week later, the answering machine disgorged another message. “Jim’s overdue for his checkup.” I slammed down my work folders and called. “Your office says my son, Jim Greiling, needs a checkup. Please clarify.” I measured my words, hardly recognizing my voice, harsh as a crow.

She put me on hold, returned. Her words tumbled out in her haste to get rid of me and Jim. Scalding anger washed over me.

“Don’t call this house again,” I snarled, “unless it’s to say your office has changed its rotten policy.”

I would weep if Jim ended up losing his teeth, after all the hopes we had for him and his teeth while he was growing up.

I’d heard tales about open clinics, where dentists triaged those in pain and the others had to return to try again to be seen. Not a great arrangement for people whose executive functioning was impaired or who might have paranoia about dentists. These clinics didn’t do anything fancy — like bridges or crowns. If things got serious, they pulled teeth. Also, MA paid for only one check-up and cleaning per year, even for people who smoked and took psych meds that were hard on teeth.

After I poured a cup of coffee, I remembered the dentist at the library meeting who had said he took MA patients. He had advocated for higher reimbursements or at least that dentists be reimbursed for no shows, something much more likely to happen with MA patients. I had reported these problems to legislators on the appropriate committees, but nothing had been done.

I hesitated. I had easily helped other people during my years in elected office, but asking for myself was another matter. I was ashamed to make the call, but thinking about Jim gave me the courage.

“I would be proud to treat Jim,” the mensch of a dentist said, even when Minnesota’s inadequate dental funding was seriously impacting his family’s budget.

My eyes misted over. One crisis averted for now.

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