Molokai Residents Are Facing New Barriers To Dental Care After Dentists Opt Out Of Insurance

Out-of-pocket costs for routine dental care can run into the hundreds of dollars.

On Molokai, half of the island's dentists now require patients to pay for care upfront, a move that has prompted some residents to give up visiting the dentist altogether.

Chris Chow, a dentist in the island's main town of Kaunakakai, said in a letter to patients that his decision to stop accepting insurance on Jan. 1 amounted to a refusal to lower patient standards, he said , his clinic has set and maintained standards for 42 years.

“They are trying to force doctors in our network to treat you according to their rules, rather than based on your needs or even how you want to be treated,” Zhou said in a letter to patients. He added, “Many Insurance companies are adding more and more restrictions on what their subscribers will allow.

The RWH Chen Building is located in downtown Kaunakakai, Molokai.The RWH Chen Building is located in downtown Kaunakakai, Molokai.
Molokai receives fewer tourists than any other Hawaiian island, but has the largest indigenous population in the state. (Cory Lamm/Civil Beat/2021)

Zhou did not respond to a request for comment for this report.

Another Molokai dentist, Boki Chung, whose website says she began asking patients to prepay for dental care in January, also did not return calls for comment.

Kimberly Svetin, president of the family-owned Molokai Drug Company, said several employees at the island's only pharmacy have said they will no longer go to the dentist because they can't afford to pay. Sweeting said other employees decided to fly to Honolulu to see a dentist who accepted their insurance.

The out-of-pocket cost for a routine dental cleaning (a recommended biannual preventive treatment to remove plaque and tartar) is typically a little over $200. For people on Molokai, an island of 7,400 people with some of the lowest household incomes and the highest unemployment rates, $200 could put them in dire straits. If covered by insurance, the same dental cleaning might cost the patient $10 or $12.

Patients who pay for dental care can seek reimbursement from their insurance company. But this can take weeks and often requires a lot of paperwork.

“I understand how difficult it is to do the administrative work required to be in the insurance business,” said Kelley Withy, a physician and professor at the University of Hawaii John A. Burns School of Medicine who tracks the state’s demand for medical professions. “And it's expensive. But it's much more difficult for people who don't know how to do it.

“What people don’t understand is when your claim is denied, you have to try again. In health care, you have to keep trying. You just resubmit and resubmit. It’s another administrative hassle, this The trouble is shifting from the dentist to the patient. Many people will give up.

A growing body of research is linking oral health to overall health, especially for pregnant women, and experts say the risks of not getting routine dental care cannot be overstated. In addition to leading to a cleaner, whiter smile, cleaning your teeth can also reduce the likelihood of gum disease, which has been linked to other health problems, including diabetes, stroke, heart disease, and dementia.

When it became apparent to some Molokai dispensary employees that they couldn't afford another dental visit, the dispensary began offering interest-free loans to help them finance treatment and tide them over while they waited for reimbursement.

“We're helping employees so they don't have to charge advance payments to their credit cards,” Sweeting explained in an email.

In addition to the increased dental financial services offered this year, Molokai Drugs plans to issue pharmacy gift certificates to all employees who floss twice a day during the month of March. Sweeting said she recently invited a guest speaker to discuss home dental care strategies with staff.

Dr. Kelly Withey, John A. Burns School of MedicineDr. Kelly Withey, John A. Burns School of Medicine
Dr. Kelly Vesey, who tracks demand for medical professions in the state, said people need to keep resubmitting their applications if they are denied. (Photo by Deborah Manoge Dimaia)

Two of the island's four dental clinics offer prepaid care to patients, limiting medical services on Molokai. But there are still dentists on the island who accept insurance plans.

An influx of new dental patients has been diverted for care to the federally qualified health center, a safety net provider that is required to accept all patients regardless of their ability to pay, said Shanna Willing, interim CEO of Molokai Community Health Center how. Even before the surge in new patients, Willing said the clinic had a wait time of about a month for dental appointments. The wait has since stretched to months.

Correction: An earlier version of this article attributed this information to chief operating officer Shawnna Wataoka, not interim CEO Shanna Willing.

As of Thursday, the next dental appointment at Molokai Community Health Center is June 6.

The health center received a $1.6 million federal grant late last year to expand its three dental clinics, adding four new patient rooms and more staff. Willing said she hopes the planned expansion will be completed within a year or two.

The Hawaii Dental Association does not collect data on which insurance plans its member dentists choose to accept, said spokesperson Melissa Pavlicek. But she said the trade group often advocates for legislation to expand and improve access to dental care.

“Certainly, we'd like to see fewer barriers for people to access care,” Pavlicek said.

Nearly two-thirds of the island's residents are covered by Med-QUEST, the state's version of Medicaid, compared with about one-third of Hawaii residents.

Civil Beat's reporting on Maui County is funded in part by the Nuestro Futuro Foundation.

Civil Beat's community health insurance is supported by the Swain Family Fund of the Hawaii Community Foundation, the Cook Foundation, the Atherton Family Foundation and Papa Ola Lokahi.

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