No treatment, and a $250 bill: Barriers to dental care send people to unprepared ERs
When Michael McCoy's tooth suddenly fell out in October, he went to the emergency room at Columbia St. Mary's in Milwaukee for help. After getting his blood pressure and weight checked and a brief wait, McCoy was told there was nothing the hospital could do — but he was still charged $250.
McCoy, 67, was sure the charge must be a mistake, so he contacted Public Investigator. But according to Ascension and his insurer, Blue Cross Blue Shield, the bill was correct.
The charge represents "facility fees" — the portion of the bill that covers the costs of delivering care, including medical equipment, nurses and other medical support staff.
"They could have told me as soon as I got there that they didn't do dental work of any kind there, instead of finding reasons to stall and bill me," McCoy said.
McCoy's situation isn't unheard of. Dental hygienist Matt Crespin told Public Investigator that across the country, people often turn to the ER for urgent dental care but are not aware that ERs usually aren't equipped to treat dental emergencies.
And because of the Emergency Medical Treatment and Labor Act, a federal law that requires hospitals to provide at least a screening to anyone who comes to the ER, hospitals can't turn a patient away.
For many, dental care is too expensive and difficult to access, Crespin said, making regular upkeep out of reach. That sends people to ERs with problems that are often preventable.
When it comes to dental pain, Crespin said most hospitals can't offer much more than ibuprofen and a referral to a dentist or a specialist.
But even a referral can be a challenge, he said. In Wisconsin, only about 30% of dentists accept Medicaid or other state-sponsored plans.
"Finding a provider that's willing to take a patient in — particularly one on an emergency basis — can be pretty challenging," Crespin said.
People with private dental insurance also face barriers to dental care. According to a 2023 analysis by KFF, a health policy research group, more than one in four adults delayed or skipped some form of health care due to cost, with dental care being the most commonly missed.
Nearly half of dentists surveyed in a 2024 American Dental Association report said they were considering dropping more insurance networks or had already done so.
The survey found that nearly all dentists who dropped insurance networks last year cited low reimbursement rates as the main reason. Many also cited "administrative burden," the study said.
To increase profits, Crespin said many dentists stop accepting private insurance at all, catering instead to patients who can afford to pay out-of-pocket for preventive and cosmetic services.
"I drive by a dental office every day near my home in the suburbs of Milwaukee that's advertising teeth whitening and Botox," he said. "That's not treating dental disease."
In McCoy's case, the hospital sent him home with instructions to take Tylenol or ibuprofen and contact a dentist in the morning. McCoy ultimately paid his ER bill, but said he did so reluctantly.
"I still think it's ridiculous to pay $250 for nothing," he said.
Crespin said Wisconsin has earned national recognition for its efforts to expand access to dental care.
In 2017, the state became one of the first to allow dental hygienists to provide care without the presence of a licensed dentist.
Wisconsin also passed legislation in 2023 to authorize the licensure of dental therapists — mid-level providers who offer preventive and restorative dental care when there are shortages of dentists. They must practice in federally designated shortage areas or serve high-need populations, according to the law.
Crespin is also on the advisory committee for a new dental therapy training program at Northcentral Technical College in Wausau that's set to start training providers to practice in places like hospitals, K-12 schools and nursing homes.
"We have to continue to find different ways for patients to access dental providers in places where they already are," he said.
Crespin, who is also the executive director of the Children's Health Alliance of Wisconsin, said the organization is piloting a project to integrate dental care into pediatrician visits.
'That seems to be helping,' Crespin said, 'but we're still early in that work.'
While barriers to dental care remain, there are some local programs working to close the gap, including:
DentaMed Healthcare's Mobile Dental Van: Every Thursday, a mobile clinic parked outside of the Sinai Medical Center in Milwaukee treats ER patients referred for dental care on-site. The van also visits schools throughout Milwaukee, Racine and Waukesha to provide free preventive services.
Wisconsin Association of Free and Charitable Clinics: You can use their online search tool to find a clinic in your area that provides free care, including dental services.
Federally Qualified Health Centers: These are clinics and health centers across Wisconsin that provide low-cost or sliding scale dental care to uninsured, Medicaid, and privately insured patients.
Ascension Seton Dental Clinic: Ascension St. Francis Hospital at 3267 S. 16th Street offers a dental clinic for urgent dental services during weekdays from 8 a.m. to 5 p.m., closing earlier at 4:30 p.m. on Mondays and Wednesdays. The clinic provides low-cost care for patients who may struggle to afford traditional dental treatment.
Quinn Clark is a Public Investigator reporter for the Milwaukee Journal Sentinel. She can be emailed at QClark@gannett.com.
This article originally appeared on Milwaukee Journal Sentinel: People seeking dental care turn to ERs, then face hefty bills
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