DENTIST’S DILEMMA

Some Maine dentists feel caught in a trap. They are required by law to warn their patients that amalgam fillings contain mercury, a poisonous chemical. And yet, if they make a filling for a back tooth from the safer – but more expensive – white material known as “composite,” and if the patient is on MaineCare, the claim may be rejected. (MaineCare is the new name for Medicaid in Maine.)

Actually, MaineCare intends to pay, but its computers mess things up. You see, Medicaid has always paid for composite fillings for front teeth, for cosmetic reasons. For a composite in a back tooth, it has been paying since 1999.

But the computers still work under the old system. If a dentist sends in a claim for a composite filling using the standard numerical code for a back tooth, the computer rejects it. The Maine Dental Association has been telling dentists in its newsletter that, for a back tooth, they have to put in the code for a front tooth and then explain that the claim is really for work on a back tooth.

MaineCare recognizes the problem and is fixing the computers. The job should be finished by the end of this month. But, under the Administrative Procedures Act, MaineCare |has to go through a rule-making routine, which requires a public hearing and four-month wait. That means the mixup will go on until about October.

So if your dentist raises doubt about a composite filling for a back tooth, you might tell him or her to take a look at that Maine Dental Association newsletter. As for the computers that cannot compute a payment code that has been in place for three years, figure that it is one of those great leaps in efficiency that technology was going to bring.