DENVER — Contact Denver7 is getting results for Colorado children who were being denied critical dental coverage. Since consumer investigator Jaclyn Allen started investigating, state leaders have taken action to fix the problem, and it's already having an impact.
There's quite a story behind one Colorado boy's giant smile in his school picture, especially when you see his x-rays.
"His teeth are all turned sideways," said his aunt, Vikki, who asked us to not use their last name to protect their privacy. "It was just a horror story looking at the pictures."
She is raising her great-nephew, and because of custody issues, Medicaid provides his dental coverage, except when they needed it most, Vikki said.
"We found out he could lose his teeth, but we would have to pay out of pocket for the orthodontic procedures," she said. "It's kind of disturbing because these are his teeth, and he needs them. And so, I couldn't understand why in the world Medicaid would not pay for something that is as necessary as having your front teeth."
Dr. Voytek Bobak is a Lakewood orthodontist, who said this child is one of many with severe dental issues that should be covered by Medicaid, but for the last year, red tape has gotten in the way.
"There was no code to submit it under," said Bobak. "They told me to try another code. I tried the other code. They said, 'No, try with another code.' You know, finally, I just gave up and started reaching out to people like you."
Contact Denver7 found the problem started last year when the American Association of Orthodontists made a code change in its manual.
In Colorado, several orthodontists reached out to Contact Denver7 saying the code change created a "bureaucratic quagmire," resulting in Medicaid denying low-income children care that could save their front teeth. Eventually, orthodontists stopped submitting qualifying cases because they knew the issue had not been addressed, said Dr. Michael McEwan, a Glenwood Springs orthodontist.
"Bureaucratic quagmire. I love that phrase he used because that's what it was," said McEwan.
The Glenwood Springs orthodontist dealt with the issue for 11 months and was forced to delay care for children who should have qualified.
"Everyone wanted to help these kids. And it's just, "Oh, well, we have to do this. No, we have to do that.' And it just was getting lost in the mix," said McEwan. "We were just told in the manual that it specifically said these codes aren't covered and that they were working on an exclusion just for cleft lip and palate, but that all of the cases would be denied. And that's what it said, ink on paper."
After Contact Denver7 first exposed the issue, the state's new Medicaid director took action.
"I didn't realize the extent of the problem," said Adela Flores-Brennan, Medicaid director for Colorado's Department of Healthcare Policy and Financing. "I think there was a lot of miscommunication and misfires over that period of time, which is really unfortunate."
Flores-Brennan said the issues have now been resolved. The state's dental coverage provider, Dentaquest, sent out a letter last week notifying providers about new codes that orthodontists can use to cover medically necessary procedures.
"I, of course, credit our stakeholders for bringing it to our attention. So, it is great. I'm glad that we've been able to resolve this for now and hope that we can do better by our kids moving forward," said Flores-Brennan.
While the state reviews cases that were denied to determine if they should have been approved, Dr. McEwan said orthodontists will be submitting cases they know would have been denied.
On Tuesday, he said he was submitting five children's cases that he believes would have been denied.
"It's some of the most severe cases (that) are now getting covered again and, you know, we can make up for the last few months here. We'll get them in and get them going," said McEwan. "And we just needed someone to sound the trumpet and catch everyone's attention."
Bobak said he is also calling children who were likely to be denied to let them know about the change.
"This just means the best Christmas presents," said Bobak. "You see, 'All I want for Christmas is my two front teeth.' They're literally gonna get them, you know?"
Vikki was prepared to pay out-of-pocket for her nephew's dental care but is now relieved that Medicaid is stepping up.
"Well, I'm thrilled. I'm thrilled that he's going to get the orthodontics and the care that he should have gotten through the state," she said. "Because he needs to be able to eat. And my goal is by next summer that he's going to be eating an apple and he's going to be eating corn on the cob again.
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