Fiona Campbell has worked hard all her adult life but has never made enough money to have health insurance. Without coverage, something as common as a toothache necessitates her spending hours just trying to wangle a dental appointment.
Over the years, Campbell says, lack of timely dental care has resulted in a loss of teeth that might have been saved, and had a dampening effect on her spirit.
Fifty million Americans find health insurance beyond their financial reach. As a result, they do not get regular dental care.
"Toothless and disempowered" is how Campbell, who recently moved from Juneau to Haines, describes herself and thousands of other low-income workers.
"During the course of my work with low-income people as a founder and board member of Life Ring, I've heard many similar heart-rending stories that echo my own experience," Campbell said. Life Ring is a support group for women.
"I'm not lazy, but I can't afford dental care," Campbell said. "There should be provisions for people like me."
Many Juneau dentists are sympathetic but not all agree with Campbell's summary of the situation.
Dentist Mark Riederer sympathizes with Campbell up to a point because of what he sees as difficulties with Medicaid.
"There is a problem with Medicaid statewide because not all providers accept it," said Riederer, in practice here since 1986.
As to his own office, "Our financial policies evolve," Riederer said. "When a new patient comes in, we try to evaluate condition real carefully and arrange priorities. If someone has a toothache at the door, we try to accommodate them. But we try to collect on a first visit."
The Empire asked all 16 Juneau dentists and the SEARHC Dental Clinic to answer two questions: What is your policy with uninsured patients? Do you accept time payments?
Kathy Bergey, dental assistant supervisor at Southeast Alaska Regional Health Consortium, said the clinic serves only Native beneficiaries. "If they have insurance, we do bill it. We never turn away clients," she said.
Of the 13 dentists in private practice who responded, one treats only children. Six said they treat uninsured patients. Five said they would take time payments. One did not wish to comment. Others qualified their answers to the question about time payments.
One said he would accept time payments for emergencies. Two said they would accept time payments over short periods only. For example, Richard Cook said he would accept time payments over a period of 90 days for "99 percent of people."
In regard to emergencies, Phillip Morritz offers his cell phone number for patients to call. Lynn Prussing and David Logan said they return calls regarding dental emergencies only from regular patients. Edward McKrill said he refers patients to another dentist for emergencies.
William Collier, an oral surgeon whose office is in the Juneau Urgent Care Building, said, "A lot of dentists will do gratis work in emergencies." He has done whole free days in the past, he said.
"Juneau is lucky in that most people have insurance," said Dorothy Cary, administrative assistant to dentist Douglas Weaver.
Theresa Bourne is missing two front teeth and is depressed over what she sees as a bleak future.
"A gap-toothed grin generates a stigma almost akin to leprosy in our affluent society," she said.
"I spent my twenties and thirties single, working three or four minimum-wage jobs, doing my utmost but never really able to get ahead, finish college or obtain medical or dental insurance," Bourne said.
"I have cleaned toilets, mopped stairs, performed day care for $3.50 an hour, picked apples, changed sheets in hotels, driven a potato truck, pumped gas. But in the last three years, I have lost three teeth which were damaged and cracked. I have been unable to find a dentist who will accept me as a patient without insurance."
Single and in her early 40s, Bourne said she lost the third tooth at Christmas after six weeks of suffering with an abscess. She believes a root canal would have saved the tooth, but said two dentists turned her away, including one whom she claimed commented about the poor, saying, "I've been taken before. If I fix your tooth, you'll never make payments.'"
Mike and Audra Thorpe are struggling with dental problems, too.
Audra, 32, is a former waitress and store clerk whose annual income ranged from $13,000 to $20,000. She is now an AmeriCorps member.
"I have some college courses. I'm not an idiot. I have held office positions in the past," she said.
Audra Thorpe moved to Ketchikan two years ago.
"In the past month I broke a front tooth. It was $200 for an emergency extraction. I went to public assistance and they said, 'We have nothing for dental.' I look like Granny of the Beverly Hillbillies."
She was quoted $1,200 as the price to replace the tooth - a price she can't afford.
Missing this upper front tooth affects her speech, giving her a distinctive lisp. Audra, a diabetic, is missing other teeth in the back of her mouth.
"It sounds horrible, but I swallow my food whole," she said. "Chewing is too painful and difficult."
Mike Thorpe, 31, is a cook with 12 years' experience. When he worked, he made about $21,000 a year, but he has been out of work for six months.
"Right now I have six cavities and half of a maxillary bicuspid. The last estimate was $1,800 to fix three teeth, not counting the cavities," Thorpe said.
He said the dentist he consulted "wants cash up front."
Joan Decker, executive director of the Glory Hole, says she hears at least one inquiry a month from someone with "a swollen jaw and a lot of pain." Decker said people earning a minimum wage have little recourse when they need dental care.
"Some people are forced to go to public assistance and have all their teeth pulled," she said.
Self-employed Juneau artist Page Bridges eluded the trauma of toothlessness because she is now covered by her husband's dental insurance.
"I have two teeth that have been missing for about four years now on the top side, and I have been trying to get money for a bridge. I have had several root canals and crowns. They were expensive, about $750 per tooth," Bridges said. "Insurance has paid for half of it. The dentist took pay in time payments. But people without insurance are in real trouble. I count myself fortunate because without his insurance, I would be in terrible trouble with no dental care at all."
There are two potential answers for the uninsured: Medicaid and the Care Card.
"The only publicly funded dental care for adults in Alaska is for adults who qualify for Medicaid. But this coverage is not available to low-income people per se," said Patricia Nault, health planner with the state Division of Public Health.
"Residents have to qualify by virtue of some other category, such as a disability. However, if they have minor children in their care, they may qualify for Family Medicaid."
This covers only emergencies, however, not preventive care - which can, in the long run, prevent many emergencies.
The state Division of Public Assistance, at 465-3551, can provide an application.
Although there is a movement afoot to fund mammograms for some women who lack insurance, "We have discovered it's difficult to get attention for dental care," Nault said.
William Collier and Kristen Schultz mentioned Care Credit as a coverage tool they recommend to their patients or help patients apply for. One of Care Credit's programs charges no interest for three months.
Care Credit, founded in 1987, is headquartered in Anaheim, Calif. Its slogan is "When you'd rather focus on patients, not payments." Maynard Panganiban, operations specialist, said 30,000 medical practices are registered most of them dental. The annual interest rate charged by Care Credit is 23 percent, Panganiban said. Physicians whose practices offer Care Credit pay an annual fee, but there is no annual fee for patients who use Care Credit cards, he added.
For more about Care Credit, call 800-300-3046 or browse its Web site, available at the juneauempire.com.
Ann Chandonnet can be reached at firstname.lastname@example.org.