Thursday, May 19, 2011

A painfully sorry state of affairs

I recently had a really bad toothache. If only my tooth was the only thing that was a severe pain.

Actually, the tooth - a lower right molar - had been bugging me for about a month, giving me occasional twinges of pain, but I thought I could deal with it. What was really going on was that I didn’t know what to do, where to go. I knew that Medi-Cal no longer funds dentistry, except for extractions and “emergencies,” and the local dentist I’ve been seeing for cleaning, funded by my parents, doesn’t take Medi-Cal and also can’t put me to sleep, which I now need when having any real work done because of my spasms. So I was going along living with it until one evening last week when I was eating pasta, of all things, and there were suddenly sharp pains and deep throbbing which eventually radiated throughout my head. I was about to discover that everything I was afraid of was true.

I began taking Tylenol, and the next morning, I had my attendant call the dental surgery center at Loma Linda University where I had gone annually for some years (they would put me under and fix any problems they found). I was in severe pain - could they help? No, Medi-Cal is no longer paying, and they no longer see Medi-Cal patients. Did they know where I could go? No. So much for Christian charity from the Seventh Day Adventists.

I felt quite small and not a little afraid, not to mention in considerable pain. My attendant and I decided to call my case worker at the Regional Center, who answered right away and got me in touch with its “dental coordinator.” That the Regional Center has a “dental coordinator” indicates that my sad problem was, sadly, not unusual. If it was not for this woman, I’d probably be still in pain, living on Tylenol and destroying my liver or something.

The woman asked about my pain and financial situation and said that getting help is tricky, but she soon had us on a three-way call with a place called Alta-Med in El Monte, about half an hour to the west. They take Medi-Cal patients because of a court ruling and take walk-ins at 1. Could my attendant and I go. Yes. Good.

The place was large and attractive and busy, mostly with Spanish speakers, and the woman at the front desk was very friendly, although harried. When I got in after more than two hours, the technicians had a difficult time getting a clear x-ray - only one is allowed - and I felt I was wasting time. Unlike the local dentist I’ve been seeing, they wouldn’t let me stay in my wheelchair, and I felt very unstable in the dentist chair, like I would fall over. No wonder it was hard getting a picture. When the dentist came, he said that he could see that, although there was no infection, the tooth was completely ground down, with the nerves exposed. He said that this was an emergency, that this was an extraction that Medi-Cal should pay for, but that he couldn’t work on me, because he couldn’t put me to sleep. I liked him - he got it - but it felt like a wasted afternoon.

When we got home, we called the dental coordinator. She didn’t answer, but she called back right after my attendant left and said that she’d be out of the office the next day but left her cell phone number.

The next day was Friday and I was in a lot of pain, not really able to eat or drink, and I was desperate not to spend the weekend like this. My attendant called the dental coordinator, but the phone seemed to be off. I had my attendant called the local urgent care center, but the woman there said I had to see a dentist. I told my attendant to call my local dentist - the one I see for cleaning - yes, I was desperate - but she called back Loma Linda. When the woman there heard about Alta-Med and the x-ray, she was much friendlier and asked for the x-ray to be faxed over. My attendant called Alta-Med, and the friendly woman at the desk said she would fax the x-ray when she could, explaining that she was working alone. Time went by, I was hurting and worrying about the weekend, and the dental Coordinator with a surgery center in Redlands, about half an hour to the east, not far from Loma Linda. It takes Medi-Cal and can put me to sleep. Could my attendant and I be there at noon? You bet.

We were at the Redlands office for less than an hour. When I first saw the dentist, I thought the pain had overtaken me and I was seeing things. He was so cute and looked like he was fresh out of high school! I pictured him surfing on weekends. (I was more than happy to have him put me under!) He also turned out to be quite smart and understanding and more or less got me. He asked me what I wanted done, mentioning a root canal, but my saying that I’m on Medi-Cal ended that conversation. There was also bad news and good news. The bad news was
*I had to have my physician sign an authorization before I could have the surgery. When I said that I’m changing doctors, because I’m not happy with the one I’ve been seeing and can’t see the new one until the end of June, I was told to see the old one. Damn!
*The earliest time for the surgery I could get was on Tuesday.
*and I would have to pay for some work that Medi-Cal doesn’t cover.
The good news was that the dentist gave me a prescription for an antibiotic and for vikadin. It turned out that the Alta-Med dentist was wrong about my not having an infection, for the pain dramatically subsided soon after I began taking the antibiotic. I only took the vikadin at night, because I didn’t want to be a complete zombie.

On the way home, we went by my doctor’s office. I was told that I had to see her, and I could get an appointment on Monday. I wasn’t happy, but my attendant pointed out to me that everything was lining up.

After a long, very quiet weekend of not doing much, including eating, I saw the doctor. Going in without my attendant and with my Vmax voice synthesizer - something I should always do - helped, cutting down her defensive arguing, and I left within minutes with the form signed.

That afternoon, my parents arrived from up north for a long-planned visit. I had not been able to tell them about my tooth, and they were dismayed to see me in such sad shape. They told me they would help with the extra costs and wondered about paying for a root canal, but I was concerned that they would have to pay for the whole surgery. (Loma Linda once told me that a surgery costs well over $1000.) When they called the office to ask questions, it was literally too late - the office was closed.

After not eating the next morning, I had to wait for more than two hours at the office in Redlands. I wondered about the other disabled people who were there, including a man who repeatedly moaned and slapped himself - where was their funding from, and were they just getting extractions? I was starving by the time of my surgery, and I again felt unstable when on the dental chair before being put to sleep - and frustrated when asked to sign a final form while on my back. The last thing I remember is the dentist looking at me - a nice last thing to see, indeed! - and asking if I was still okay with what he and I had agreed on on Friday.

I was pretty much zonked out for the rest of the day (I don’t remember waking up from the surgery or getting into my van - I would have loved seeing my attendant navigate my motorized wheelchair into my van!), and, with eating jello and fried eggs and hot cereal, I was more or less fine, if a bit groggy, the next day. I was a bit sore, but the toothache was gone - gone! I never did hear back from Loma Linda and don’t know if the nice busy lady at Alta-Med ever did fax them the x-ray.

I have left out some details, a few twists and turns, but you get the gist. Yes, I got what I needed, thankfully, but the system was, as someone commented and to say the very least, clunky. Be warned - or grateful for your coverage and funding that you have.

1 comment:

  1. Wow, what an ordeal. The last thing I want to do now is not take advantage of what I got. Medical has me paying back overpayments until the next five years and dental was a thing my wife put me on to subsidize my medical at my workplace. Needless to say the vision and dental that was part of a benefit package I passed up, since I was not going to get my own dental, puts me out of vision coverage at least for the next year. I say, John, one who now knows the ins and outs of getting medical services, does the prospect of getting put out by the young physician ease some of the drams?, or was the pain of not being covered or cared for, a little over the top, especially knowing the attitudes of professionals at Loma Linda were not any better than the ones who were too damn busy to get it?
    I hope the best for your next trip to the dentist offices. May I suggest a remedy?, a social dynamic change in public opinion for the disabled and those who really need more than a deep cleaning, which by the way is usually a once gloss over, with corruptible assembly line corporative drillers from one cubicle to the next.
    Next chance I get, I will make that much put off appointment and keep current with the program. I now know it is fortunate I can get what I want easier than most, but somehow I still complain of my situation, a human dilemma, or just plain immature? I admire your ability to take advantage of the moment doing what you want and enjoy, the one attribute most are unaware they have but not willing to act on doing anything about it. Love you John, Peace.