Oregon Health Plan Catch-22 leaves woman with no teeth

Oregon Health Plan Catch-22 leaves woman with no teeth »Play Video

PORTLAND, Ore. – A Portland woman says no one would want to be in her shoes.

Karyn Leckbee suffers from a long list of medical problems and turned to KATU’s On Your Side investigators after she says her dentist told her she didn't qualify for getting dentures – which are needed to replace the teeth she recently had removed.
    
KATU News has learned that it was a change in Oregon law designed to save money in the Oregon Health Plan that set her weeks of pain and frustration in motion.

Leckbee spends much of her day taking 30 medications. She used to be an able-bodied construction contractor until a car wreck left her with a spinal injury and a long list of medical problems.

"I have congestive heart failure, COPD, diabetes, lupus," Leckbee said, ticking off a list of maladies.

The many medications for those conditions attacked her teeth. She had them all removed at Willamette Dental in procedures paid for by the Oregon Department of Human Services (ODHS).

She qualified for the treatments because she is permanently disabled, poor and on the Oregon Health Plan, which allowed for the tooth extraction and dentures – in 2009.

The procedures were done in mid-September of 2009, but because her body is slow to heal, Karyn had to wait until December – longer than normal – for procedures that must be done before the dentist can put in  dentures. Because of her heart condition, the dentist couldn't do the procedures all at once and told her to come back.

But on Jan. 1, new cuts in benefits kicked in for the Oregon health plan to help the state balance the budget and save $15 million.
 
The new rules say: "...dentures will still be covered as long as they are done within three months of the client's teeth being extracted."  

By Jan. 1, it had been three months – and 15 days – for Leckbee.

A bigger deal for Leckbee: the new rules also cut coverage for alveoplasty, a procedure she needs before she can be fitted for dentures.

"When Willamette Dental called me for the appointment, they said I would have to come up with $2,000, and I said “What?”” she recalls. “And they said “Well, your services are no longer covered.” And I said “What do you mean? I should have been grandfathered in.'”

"I'm sicker than most people,” Leckbee told KATU News, “and I feel like I’m being punished because I’m sick. I should be able to get my teeth."

Willamette Dental declined to talk about Leckbee’s case on camera. However, a company spokesperson said they are troubled by the cuts and issued a statement saying in part:

"Unfortunately, it's going to be more of a problem in the coming years because alveoplasty is not covered" for future patients.
   
Leckbee’s case is an extreme one. However it is representative of cuts thousands of poor Oregonians are facing due to the Oregon Health Plan being scaled back for budgetary reasons.

In response to a question about the plan now leaving people without adequate health care, ODHS Spokesperson Patty Wentz said, “One of the things that happens is [that] not everyone we would hope, and that clients would hope, [are being] covered. There is going to be some reduced benefits."

Russ House, general counsel for Willamette Dental, told KATU News it has reviewed Leckbee's case. "When it got to a manager, she said, 'Wait a minute, we've got to complete this woman's treatment' and they will,” House said.

That means Willamette Dental will eat the cost of Karyn's treatment that isn't covered.

"I'd be happy to have my teeth, and have the work done… it would wipe out everything,” Leckbee said.

Willamette Dental insists it made the decision to complete Karyn's treatment before KATU News got involved.

State officials said 175,000 people on the Oregon Health Vision and Dental plans are impacted in some way by cuts in services.

ODHS urges clients to call with questions about their coverage. That phone number is (503) 945-5944; the teletype number is (503) 945-6214.