Universal Healthcare Update

Does Medicare Cover Dental Procedures?

Currently, Medicare coverage of dental services is very limited. Medicare does not cover routine dental care or most dental procedures such as cleanings, fillings, tooth extractions or dentures. Medicare does not pay for dental plates or other dental devices. In general, you pay for 100% of dental services.


Section 1862 (a)(12) of the Social Security Act states in partial that Medicare will not cover dental care, "where such expenses are for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth.” Structures directly supporting the teeth means the periodontium, which includes the gingivae, periodontal membrane, dentogingival junction, cementum of the teeth, and the alveolar bone (i.e. alveolar process and tooth sockets).

The dental exclusion was included as part of the initial Medicare program. The principle being that Coverage is not determined by the value or the necessity of the dental care but by the type of service provided and the anatomical structure on which the procedure is performed.

Overview
Currently, Medicare will pay for dental services that are an integral part either of a covered procedure (e.g., reconstruction of the jaw following accidental injury), or for extractions done in preparation for radiation treatment for neoplastic diseases involving the jaw. Medicare will also make payment for oral examinations, but not treatment, preceding kidney transplantation or heart valve replacement, under certain circumstances. Such examination would be covered under Part A if performed by a dentist on the hospital's staff or under Part B if performed by a physician.

Statutory Dental Exclusion

Section 1862 (a)(12) of the Social Security Act states, "where such expenses are for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth, except that payment may be made under part A in the case of inpatient hospital services in connection with the provision of such dental services if the individual, because of his underlying medical condition and clinical status or because of the severity of the dental procedure, requires hospitalization in connection with the provision of such services."

Overview
Currently, Medicare will pay for dental services that are an integral part either of a covered procedure (e.g., reconstruction of the jaw following accidental injury), or for extractions done in preparation for radiation treatment for neoplastic diseases involving the jaw. Medicare will also make payment for oral examinations, but not treatment, preceding kidney transplantation or heart valve replacement, under certain circumstances. Such examination would be covered under Part A if performed by a dentist on the hospital's staff or under Part B if performed by a physician.

http://www.cms.hhs.gov/MedicareDentalCoverage/

The reconciliation bill lowers payments to insurers through Medicare Advantage. In this program, instead of reimbursing healthcare providers directly, the government hires insurance companies to provide coverage for Medicare beneficiaries. These insurers sometimes provide benefits that are not normally part of Medicare, such as dental insurance. Currently the government pays about 14% more to these companies than it would have paid through conventional Medicare. The reconciliation bill would lower these payments to 95% of Medicare spending in areas where conventional Medicare payments are high and 115% where the payments are low.
http://www.drbicuspid.com/index.asp?sec=ser&sub=def&pag=dis&ItemID=304180

So where do I sign up?

Would Jesus vote for the health care bill? YES...

12 And Jesus went into the temple of God, and cast out all them that sold and bought in the temple, and overthrew the tables of the moneychangers, and the seats of them that sold doves,

13 And said unto them, It is written, My house shall be called the house of prayer; but ye have made it a den of thieves.

I can't claim to speak for Jesus...

But I don't picture him being easily drafted into service to a gangland operation like the demoKKKrat party. He didn't seem to like gangsterism generally:

the dems are going to start feeling some of the pain next November.

Once again, David, single-payer health plan countries, based on fifty years of real world experience, have higher life expectancies, better public health metrics like infant mortality, better doctor-patient ratios, administrative costs around 75% lower, AND cost around half as much per pperson as the US system, and consume a smaller fraction of GDP, while covering EVERYONE. If you are so self-centered that you feel like screwing over your fellow citizens, David, go ahead and do so. Don't expect praise for it.

Look at the numbers, gunga. There are a lot of them.

DAMNING reports on the state of the National Health Service, suppressed by the government, reveal how patients’ needs have been neglected.

They diagnose a blind pursuit of political and managerial targets as the root cause of a string of hospital scandals that have cost thousands of lives.

The harsh verdict on the state of the NHS, after a spending splurge under Labour between 2000 and 2008, raises worrying questions about the future quality of the health service as budgets are squeezed.

One report, based on the advice of almost 200 top managers and doctors, says hospitals ignored basic hygiene to cram in patients to meet waiting-time targets.

“Managers crowded in patients in order to meet waiting-time targets and, in the process, lost sight of the fundamental hygiene requirements for infection prevention,” the report stated.

There were subsequent failings at health trusts in Basildon in Essex, and Mid Staffordshire. Filthy wards and nurse shortages led to up to 1,200 deaths at Stafford hospital.

Lord Darzi, the former health minister, commissioned the three reports from international consultancies to assess the progress of the NHS as it approached its 60th anniversary in 2008. They have come to light after a freedom of information request.

The first report, by the Massachusetts-based Institute for Healthcare Improvements (IHI), identified the neglect of patients as a serious obstacle to improving the NHS. “The lack of a prominent focus on patients’ interests and needs ... represents a significant barrier to shifting the trajectory of quality improvement in the NHS.”

One heading in the report says: “The patient doesn’t seem to be in the picture.” It adds: “We were struck by the virtual absence of mention of patients and families ... whether we were discussing aims and ambition for improvement, measurement of progress or any other topic relevant to quality.

“Most targets and standards appear to be defined in professional, organisational and political terms, not in terms of patients’ experience of care.”

This weekend it emerged the recommendations of the reports, intended to help the NHS improve, have not even been circulated.

The stark assessments, collected from leading NHS clinicians and managers, include:

A damaging rift between doctors and managers: “The GP and consultant contracts are de-professionalising, and have had the peculiar effect of simultaneously demoralising and enriching doctors. We’ve lost the volitional work of the doctors and far too many of us are now just working to rule.”

Pointless new structures. “Stop the restructurings. The only thing they generate is redundancy payments.” One body responsible for improving standards reported to five different ministers and had three different names in the space of 30 months.

A culture of fear and slavish compliance. “The risk of consequences to managers is much greater for not meeting expectations from above than for not meeting expectations of patients and families.”

The IHI report, whose interviewees included Lord Crisp, chief executive of the NHS between 2000 and 2006, also described a system of self-assessment where only 4% of trusts are externally inspected.

A similar picture emerges in the second report, by the US-based Joint Commission International. It says the “quality and integrity of [NHS]performance data is suspect”.

Dennis O’Leary, its lead author and an international expert on patient safety and improvement, said it was not intended as an exposé but as a series of useful suggestions for change.

“Our instructions were to pull no punches and tell it like it was, but the report wasn’t overstated,” he said. “It was how we saw things based on interviews with more than 50 people.”

The third report, by the US-based Rand Corporation, expresses surprise at the lack of a requirement to identify the specific drug involved when patient accidents are reported.

In 2008 Darzi issued his own blueprint for the future of the NHS, High Quality Care for All, but resigned from the government last July to return to his surgical commitments.

Last week he said: “The NHS is continuing a journey of improvements, moving from a service that has rightly focused on increasing the quantity of care to one that focuses on improving the quality of care.

“High Quality Care for All has gone to every NHS organisation in the country where it is being implemented to ensure that the NHS delivers safe and effective treatment every time, with our patients being treated with compassion, dignity and respect when in our care." A Department of Health spokesman maintained that the three reports were never intended for “wider circulation” and said they were extensively discussed by experts advising Darzi on the production of his report.

However, Brian Jarman, emeritus professor at Imperial College London and an expert in hospital standards, said the findings should have been made available to Robert Francis QC, who led the inquiry into the Mid Staffordshire NHS Foundation Trust.

He said: “These reports have never seen the light of day. We desperately need a better monitoring system for the NHS which actually works.”

A man of 22 died in agony of dehydration after three days in a leading teaching hospital.

Kane Gorny was so desperate for a drink that he rang police to beg for their help.

They arrived on the ward only to be told by doctors that everything was under control.

The next day his mother Rita Cronin found him delirious and he died within hours.

She said nurses had failed to give him vital drugs which controlled fluid levels in his body. 'He was totally dependent on the nurses to help him and they totally betrayed him.'