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Colorado children denied dental care to save teeth after code change quagmire

Colorado orthodontists say Medicaid red tape is hurting children
Colorado children denied dental care to save teeth after code change quagmire
Posted at 6:41 PM, Nov 07, 2022
and last updated 2022-11-07 20:41:36-05

LAKEWOOD, Colo. — Colorado orthodontists say Colorado's most vulnerable children are being denied dental care that could save their teeth, all because of bureaucratic red tape. They say a simple code change has changed everything.

At Bobak Orthodontics in Lakewood, Dr. Voytek Bobak has been helping kids smile for nearly three decades, but this year, something changed.

"The bottom line is, for the last 11 months, I have not been able to treat kids that desperately need orthodontic treatment to prevent severe permanent damage to the front teeth," Bobak said. "It's called medically necessary orthodontics, and if they don't get treatment, they could potentially lose teeth."

The problem started after the American Association of Orthodontists announced a code change in their manual.

Lisa Austin, vice president of the Colorado Orthodontic Association, said the new code was supposed to eliminate redundancy for certain children's procedures, but in Colorado, instead of switching to the new code, the state Medicaid dental benefits provider DentaQuest simply stopped covering these childrens' procedures, denying critical coverage to low-income families.

"What it translates to is kids of younger age that might not be getting treatment that could definitely benefit from it," Austin said. "It just made it very difficult for the families who can't necessarily afford orthodontic treatment for their children, and you don't want to cause long-term problems. So, that's kind of the predicament we're in now."

Dozens of Bobak's patients have been denied, including a little girl whose front teeth are growing into each other and will have to be pulled if she does not have treatment.

"It's a simple treatment. I've done it thousands of times, and now I can't do it," Bobak said. "This little girl cannot get a treatment, although technically she should."

Other states, such as Montana, deleted the old codes, changed to the new ones and kept covering children.

Michael McEwan, an orthodontist in Glenwood Springs, said that his office has seen every child denied treatment in the last year because of the code issues.

"I think everyone wants this, but it's just fallen through the cracks," McEwan said. "They're the kids that need it the most, and there are just certain things we have to do at age eight, nine, and 10 in certain cases. And if we miss that window, we've missed the chance to fix someone's bite and change their life and prevent problems that can't be fixed later."

"We have dozens of orthodontists who are facing this," McEwan continued. "I've submitted these cases and appealed them. I've requested peer-to-peer reviews on these cases. And I haven't been able to get these through."

McEwan said submitting cases under the wrong codes could potentially limit procedures for the child in the future.

The Colorado Department of Health Care Policy & Financing administers the Medicaid program in the state and acknowledged the issue in this statement to Contact Denver7:

"We want to assure our Health First Colorado members and orthodontic providers that Medicaid covers medically necessary orthodontic services for kids as part of their benefits. We are actively working with our providers and DentaQuest to resolve any confusion stemming from the national change in billing codes. Providers are reminded they can submit a request for any service they believe is medically necessary using any nationally approved code. Providers are encouraged to contact DentaQuest provider services for any denials they receive."

But after months of meetings and finger-pointing, Colorado orthodontists said the state's response is misleading. Orthodontists and families can't cut through the red tape and need help — not for themselves, but for Colorado children.

"I think it's just a bureaucratic quagmire where departments aren't talking to each other. There's blame being shifted around. And the end result is, it's the kids that suffer," Bobak said.

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