Tuesday, April 28, 2015

The shame of being poor

     I've pretty much been poor my entire adult life. Well, actually I think I was somewhat poor as a kid too, but my mom was pretty awesome and I didn't really realize we were poor. That's a shout out to my mom. Yay, Mom! I think I only knew we were poor because I got reduced price lunches at school.
     Throughout my seventeen years as an adult, I've nearly always (with the exception of a few months here and there) worked full time or went to school full time. Financially, my head has always been just barely above water, and I don't entirely know why. Working in the non-profit sector doesn't exactly help. It also doesn't help that I have a BA in psychology and live in Boulder, where people like me are a dime a dozen. And oh yeah, it's Boulder, where the cost of living will reduce you to tears. But I didn't metaphorically come here today to discuss why I'm poor. I came here to discuss how ashamed I am about it.
     There. I said it. I'm ashamed. Excuse me while I go cower under the bed.

    Okay. I'm back. I've always been ashamed of being poor. I hate to accept help from others. I do accept help when it is offered, and I'm grateful that there are people in my life who are willing to help me, but I hate that I need their help. I hope to one day be able to give back, but I don't know when that day will be.
      I've often made only slightly more than enough to cover rent and bills, leaving me with very little money for food. Yes, a jar of peanut butter and nutrition-less white bread are really very cheap, but one can only have so much energy on a diet like that. So, I spend a little more money to eat semi-healthy, and to also enjoy the occasional comfort food. Then I inevitably feel guilty for buying moderately priced food that actually tastes like food. One of the worst feelings I've ever had is guilt that I bought food.
     At this point in my life, my situation is close to as bad as it's ever been, except for that time in 2006 when I was homeless, but that's a story for another post. I'm currently on temporary disability due to a workplace injury and don't know when I will be able to return to work. Prior to my injury, I was making just barely enough to survive. My worker's comp benefits are two-thirds of what my wages were. Two-thirds of just barely enough is not enough.
     As I described in my "Comfort Dental leaves a discomforting taste in my mouth" post, I'm currently in need of a root canal. I have used up my allotted Medicaid dental funding for the year. Today I visited an agency in Boulder which provides emergency housing, food, medical, and other assistance to people in need.
      I really didn't want to contact this agency. I am grateful that this and other charitable organizations exist, but I've always thought: those are for other people. They're not for me. I must've done something wrong. Surely someone else is more deserving of that money.
     Friends, family, the dentist, and the horrendous pain in my mouth convinced me to make an appointment. Once again I feel the shame of being poor.
     Just last week my boyfriend's mom gave me a purple leather Coach handbag that she's never even used. It's awesome. Because it's purple. Purple is awesome. Yay! Look at me all classy with my Coach leather handbag! Then I think: I can't walk into this place with an expensive handbag, they'll think I'm trying to scam them. So what did I do? I stuffed the purse inside an ugly canvas grocery bag before going inside. Shame on me.
     I realize on a cognitive level that the shame I am feeling is not my own. It didn't come from me. I know that I didn't do anything wrong. I didn't choose to be poor, and I didn't choose to get injured. It's just life. But what I know logically and what I feel inside are two very different things. I feel ashamed for needing help.
     I'm trying let these feelings go. I'm trying to hold my head up high. Actually, I do hold my head up high, but inside I'm cowering in a shell. These feelings are not my own. They come from society and the various stigmas that unfairly get placed on the lower class.
     Today I realized something that makes me feel sick inside. Society's stigma on poor people is so imbedded in my brain, that I just don't feel it in regards to myself. I feel it about other low-income people as well. Today I was sitting in the waiting room thinking about the people around me. Part of me was thinking along these lines: "I'm not like them. I didn't do anything wrong. They probably don't have a degree like I do. I'm better dressed than that person over there."
    Yes, these are thoughts that have gone through the back of my mind on more than one occasion. I hate that I sometimes have thoughts like this and I really hate admitting that I have them. There is no actual reason I should be thinking this way. I don't know anything about these other people. They have hopes, dreams, talents, and lots of other people-like qualities. They aren't worse than me. They are stuck in a bad situation through no part of their own, just like I am. I know this on a cognitive level, just like I know that I am not a bad person, but I don't always feel it deep down where it counts.
     Now the question is: do I view other poor people as "worse than me" because I want to be able to view myself in a better light, or is it because how I feel about them is a reflection of how I truly feel about myself? I don't know. Perhaps it is a little of both.
     I am writing this with the hope that putting my feelings out there will allow me to let go of them. I don't truly believe poor people are bad people. I don't truly believe I'm a bad person. It's an idea that has been instilled in me, and I want to get rid of it.  I'm going to hold my head up high and try my damnedest not to be ashamed, and to have compassion for those in situations similar to my own. Actually, I'm just going to try and have compassion for others. Period.
     One of my favorite sayings is: it can always get worse. And it often does. But when it gets worse, I just tell myself: it could aways get even worse. I find it comforting. I hope you do too.

Wednesday, April 22, 2015

Comfort Dental leaves a discomforting taste in my mouth.

     I recently had a less than satisfactory experience at the dentist. Now you might be thinking, "Of course it wasn't satisfactory, it was the dentist." But this less than satisfactory feeling is more than the normal discomfort of having someone try to hold a conversation with you while they stick objects in your mouth. This experience has left me so upset that I have decided to make it the subject of my very first blog post, despite the number of other topics I am itching to blog about.
     I am currently a Medicaid recipient. I am lucky enough to live in Colorado, which provides comprehensive dental care for adults on Medicaid (fewer than half the states do). After searching for dentists in my area that accept Medicaid, I chose a Comfort Dental location very near to my house. My initial experience at Comfort Dental was about average. My comprehensive exam included X-rays. The dentist was friendly and adept at explaining what my teeth needed and what was covered and not covered by Medicaid.
     I scheduled a follow-up visit to have a full cleaning, during which I also had two cavities filled. The dentist informed me that I had a tooth which needed a root canal. He explained that Medicaid would have to approve the procedure before the tooth could be treated. He sent out the request and said it could take anywhere from two weeks to several months to hear a response.
     I received a letter from Dentaquest (Colorado's provider of dental care for Medicaid recipients) stating that my treatment was not approved. I immediately called Comfort Dental to see what my alternatives were. I was surprised to hear that they had gone ahead and appealed this decision on my behalf. I was pleased that I did not have to go through the inconvenience of appealing the decision myself, and thought this was very good customer service on the part of Comfort Dental. At this point I was very happy with them. A week later I received a call from Comfort Dental stating that the treatment was approved and I scheduled an appointment to have the work done.
     On the day of my appointment, the waiting area was very crowded. Since it was a weekday evening, this came as no surprise. After a somewhat long, but not completely unreasonable wait time I was brought back to the exam area. The dentist explained to me that Medicaid wanted the procedure completed over a course of 3 visits, and explained what each visit would entail. After the first part of the treatment was complete, I was led to the reception desk to schedule my next appointment. At no point during that visit was payment mentioned. I knew that Medicaid covered up to $1000 per year. Since no one spoke to me about payment, I simply assumed that the cost of the treatment was at or under $1000.
     On the day of my next appointment, I was immediately called to the reception desk and told that I owed $300+. I asked why I was not informed of this fee prior to beginning treatment. The receptionist told me in a brusque tone that I was. I told her that I had not been. She pointed to my chart, which had the date of my previous appointment and a check mark next to it stating that I had been informed of the fee. I told her that no such conversation ever took place. I explained that their office was very busy that night, and that I must have been overlooked by the office staff. The woman continued to argue with me. I explained that my financial situation was tight, and had I been aware of this fee, I may not have gotten the treatment done at that time. After I continued to reiterate that no one had spoken with me about the amount I would be responsible for, the woman finally relented and apologized for the oversight. I stated that I would like to reschedule that day's appointment, as I would need to go over my finances in order to fit in this unexpected expense.
     After going over my budget and deciding that the tooth was a necessary expense, I rescheduled my appointment and paid the $300+. My root canal and crown were completed with no further surprises. This was in March of this year. At that point, my Medicaid funding was used up.    
     Unfortunately, a few weeks ago I developed a toothache. I want to make it clear that this new toothache was a different tooth than the one Comfort Dental had just worked on. This ache quickly became painful to the point of distraction. I made an appointment at Comfort Dental. I was nervous about finances because I knew I had used up my Medicaid coverage, but I also knew that something needed to be done.
     The receptionist explained to me that emergency visits were still covered, so I was relieved, at least on that note. After a quick exam the dentist found the problem tooth. The tooth was one that had previously had a root canal done about 5 years ago by a different dentist. He gave me a prescription for the antibiotic penicillin and explained that in most cases the antibiotic treatment can buy a month or two until a permanent solution becomes necessary. The receptionist printed me a treatment plan and cost. She gave me the name of an agency that might be able to provide me with financial assistance for the treatment. I was unaware of this agency, so I was grateful that she gave me this information. I left feeling hopeful that the antibiotic could buy me some time until I could find a way to afford the treatment.
     The disappointing part of the visit was that at no point did the dentist ask me how much pain I was in, what I was doing to relieve the pain, and how distracting the pain was. I was in a great deal of pain, and hoped that the antibiotic would begin its "magic" quickly. I knew that the antibiotic was the most important thing, so I decided to just deal with the fact that I was not given any medication for the pain.
     Unfortunately, it took three days for the penicillin to begin working. These three days were spent in moderate to excruciating pain. Due to a prescription medication I am on, I am unable to take ibuprofen, aspirin, naproxen, or any other NSAID (non-steroidal anti-inflammatory drug). The only OTC (over the counter) pain reliever I am able to take is acetaminophen. I took the maximum dose of acetaminophen every six hours. This did relieve the pain to some extent, however it wore off after about 3-4 hours, and I was left waiting 2-3 hours before I could take another dose. The pain became so excruciating that I was unable to do much other than lay in bed.
     Two days after my visit to Comfort Dental, I called them and explained that I was still in a great deal of pain. I asked how long it would be until the penicillin was expected to take affect and if there was anything else I could do in the meantime for the pain. The receptionist who answered the phone did not even put my question through to the dentist. She informed me that if the antibiotic wasn't working, immediate treatment was necessary. I told her that I was still looking into funding for the root canal. She then began trying to sell me on CareCredit, a credit-based way to pay. I explained that I was not interested in that route. She continued to try to persuade me, explaining that I could use a co-signer for CareCredit in order to help my chances of qualifying. I politely told her that I was not interested and ended the phone conversation.
     To my relief, my pain slowly began to abate. By the next day, the pain was nearly gone. The course of penicillin I was given was for 10 days. The day following the end of my penicillin treatment, my toothache returned. It didn't take long for this toothache to reach the excruciating heights it had been at prior to taking the penicillin. This was on a Sunday, so I was stuck taking acetaminophen and rinsing with salt water, which only provided a small amount of relief.
     I went to Comfort Dental the following morning. I explained that I did not have an appointment but that I was in a great deal of pain and would appreciate it if I could be seen. They were able to make time for me, to which I was grateful for. I thanked them for their flexibility and understanding.
     I explained my situation to the dental assistant. She became very distressed and stated that my situation was quite serious. She said I could wind up in the emergency room if I wasn't careful. I told her I understood it was serious, and was hoping that a stronger antibiotic could at least stave off the infection until I was able to receive funding for the procedure. I explained that I had an appointment with an agency that could provide me with financial assistance in one week.  She was very adamant that the problem needed addressed immediately, and suggested that the tooth be extracted that day. I immediately balked at this. I informed her I did not want to extract the tooth unless it was the absolute last resort, and I did not believe we were at that point yet. I again asked if I could at least have a stronger antibiotic. She still seemed to disagree with me, but then went and got the dentist. When the dentist arrived, he said the only thing we could do was to try another course of penicillin, and he gave me another prescription. Again, I was not asked how bad the pain was, what I was doing to alleviate the pain, or given any suggestions as to what to do about the pain.
     I was not completely satisfied with how the visit went. From the little knowledge I have of infections and antibiotics, I was unsure that another course of penicillin would have any effect. I decided to get a second opinion, so I made an appointment at Boulder Dental Center. I chose them because my boyfriend is a patient there, and he spoke highly of the practice. Boulder Dental Center does not accept Medicaid, so I went in and stated that I had no dental insurance.
     Unfortunately, I had to pay $95 for the visit to Boulder Dental Center. I don't have a lot of extra money, but I decided that the cost was worth it to help save my tooth and stop the infection. The office staff was friendly, competent, and upfront about the fees I would owe. The dental assistant was very personable. My tooth was examined by 2 different dentists. I appreciated the thoroughness.
     They identified the problem tooth, stating that it had had a root canal in the past, a fact that the dentist at Comfort Dental had also noted. However, the dentists at Boulder Dental Center then made a statement that immediately sent a red flag up in my head about Comfort Dental. Boulder Dental Center informed me that when a tooth that has already had a root canal gets an infection, a stronger antibiotic than penicillin is required in most cases. I wondered why the providers at Comfort Dental did not know this.
     I was given a prescription for augmentin, a combination of two antibiotics: amoxicillin and clavulanate potassium. I was also given a prescription for a narcotic painkiller. Finally. I was actually going to get some relief from the sensation of a giant hammer pounding on the inside of my mouth.  I filled the prescriptions and went home. I was able to relax and concentrate on the things I needed to do, rather than lay in bed focusing on nothing other than the throbbing pain in my tooth.
     That was two days ago. The augmentin appears to be working. I have little to no pain in my tooth (and this is without needing any more pain medication, OTC or prescription.) Yay!
     I feel at the very least, mistreated by Comfort Dental. At the worst, I feel neglected. They did not take the proper time to evaluate my specific situation and attend to the specific needs of my case. I do not understand why they were unwilling to give me something to relieve my pain, and I don't understand why they were unwilling to try an antibiotic other than penicillin. My experiences at Comfort Dental have left me upset and uncertain about ever returning there.
     Unfortunately, this story is not yet over. Next week I will be looking into emergency funding to see if I can have the root canal. I am hoping to be able to have it done at Boulder Dental Center rather than Comfort Dental, unfortunately that choice will be up to the organization providing the funding. Because Comfort Dental accepts Medicaid, if I get the root canal through them I will receive the Medicaid discount. Since Boulder Dental Center does not, the estimated cost of treatment is higher.
     I hope that my negative experiences at Comfort Dental are unique, and not ones that others have had to experience. At this point, I am unsure what I am going to do. At the very least I feel that it is important to let others know of my experiences so they can be well informed when making their own dental care choices. Please feel free to comment, share your own experiences about Comfort Dental, Boulder Dental Center, or any other practice. I would love to hear your experiences.  Please share this if you feel this story should be heard by others. Thank you for reading. I will keep you updated on the continued adventures of my poor achy tooth.