Gilroy
– Dr. David Nader has lost money, lost patients, and could lose
his San Jose clinic this year, he says, due to the hassles and
expense of treating Gilroy patients on Denti-Cal, California’s
public dental program.
Gilroy – Dr. David Nader has lost money, lost patients, and could lose his San Jose clinic this year, he says, due to the hassles and expense of treating Gilroy patients on Denti-Cal, California’s public dental program.
“It’s been very difficult,” said Nader, a soft-voiced man who sees Gilroy patients at City Dental Center on Monterey Street. “But if I don’t take them, nobody else is going to.”
Denti-Cal care is scarce nationwide, and in Gilroy, it’s even scarcer. Nader is one of only two Gilroy dentists who currently accept Denti-Cal patients, out of at least 25 listed dentists. Few are willing to take the low payments and mounting paperwork, and those that do are swamped with needy patients, said Kelly Hardy, a senior health policy associate with Children Now.
“Too few dentists accept Denti-Cal,” said Hardy. “The common-sense answer is to raise the reimbursement rates, so dentists will participate. But there isn’t the political will to do it.”
Denti-Cal patients flock to Nader, clogging his calendar. Scheduling is a nightmare, he says, and he’s lost other insured patients, who tire of the waits. And poorer patients are more likely to miss their appointments, forcing dentists like Nader to chuck or re-sterilize instruments and chair-side materials, said Patti Roberts, a Health Services spokesperson.
Meanwhile, Nader has hired an assistant “just for Medi-Cal paperwork,” who spends 20 to 30 hours each week compiling the documents, photos and X-rays required to keep state reimbursements flowing.
“Some providers contend that they lose money treating Medi-Cal patients,” said Roberts, and “some dentists may feel [the paperwork] is burdensome. However, this is a taxpayer-funded program, and caution must be taken to avoid the misuse of public funds.”
Dentists complain that the program doesn’t repay them in full, stranding them with the bills. Some prefer straightforward charity care to navigating the state’s system.
“You don’t get a dollar for a dollar, with Denti-Cal,” said Kathleen Cooper, executive director of the Santa Clara Dental Society. “And a lot of procedures aren’t covered. It’s hard to get people to cover root canals, for instance. Denti-Cal only covers a few of the front teeth for root canals.”
Nader complained, “If they need crowns, Denti-Cal doesn’t cover crowns. They don’t cover bridges. Either I do it for free, or I try to patch it up, with a large filling.”
Despite its limits, California provides the broadest public dental care in the country, said Roberts, and can enroll providers speedily, in 50 days or less. Even an annual services cap of $1,800, imposed on patients age 21 and older, can be waived for necessary treatments, such as dentures, tooth extractions and long-term care.
“In all cases of medical necessity,” said Roberts, “some form of treatment … is available.”
Child advocates worry that dentistry treated as an extra, not an essential. Tooth decay far outstrips other childhood diseases: One-third of California’s third-graders have untreated cavities, according to Children Now, which recently dealt the state a C- grade for its child dental services.
Dental ailments can spread beyond the mouth, and even kill. In Maryland, a 12-year-old boy died Sunday, after bacteria spread from a tooth abscess to his brain.
“Dental care isn’t an extra,” said Hardy. “It’s not something that can be put off.”
Despite the frustrations, Nader won’t stop seeing Denti-Cal patients. He’d sooner close his smaller San Jose office, than abandon his low-income clients, concentrated in Gilroy. If he can, Nader says he’ll keep both offices open. But splitting time is increasingly difficult, as Denti-Cal patients pour into his clinic.
“Most doctors don’t accept them,” he said quietly. “Yes, it’s a lot of extra paperwork. But it’s what we have to do.”
