Frequently Asked Questions
Over the years, our Patient Care Center has spoken with many of our facilities, patients and their families. Here are answers to the most Frequently Asked Questions about our OHM® Program and how it works.
Q: Nursing home residents are too old…why bother with dental care?
A: Age has nothing to do with the need for oral healthcare. Nursing home residents are people who have feelings and deserve to be pain-free and comfortable. Often they cannot tell you that they have pain. Our dental care team works with the resident’s entire care team at the nursing home to prescribe an oral healthcare plan to improve their quality of life. People who live in nursing homes often take a myriad of medications which cause dry mouth. They may not be eating because bacteria in their mouth caused by poorly fitting dentures or tooth decay makes food taste bad. Sometimes sugar is the only thing that they will eat, and that can lead to tooth decay as well as complications with diabetes. Good oral health is a key to overall health and quality of life for nursing home residents.
Q: Doesn’t this get done by the nursing home?
A: The nurses are trained in the overall daily care of their patients. They are not trained in dentistry. They are not able to diagnose oral health problems, and they don’t have the knowledge or equipment to perform the necessary services. PrevMED has a state-licensed Dentist and/or Dental Assistant or Registered Dental Hygienist (RDH) who knows how to treat oral hygiene issues in nursing home residents. We are a part of the resident’s extended care team.
Q: What are all the services you provide?
A: The PrevMED OHM® Program has been prepared by one of the foremost geriatric dental/medical experts in the country. It is focused on preventing bacteria and infection in the mouth. Studies have shown that after approximately 30 days the bacteria in the mouth becomes more toxic. Our Dentists and Registered Dental Hygienists (RDH) follow a twelve-month individually prescribed program that will restore the mouth to health and keep it that way. This includes a complete oral assessment, cancer screening, x-rays, tooth scaling (debridement), polishing (prophylaxis), infection control and treatment for dry mouth, ultrasonic denture cleaning, relines, and etching, along with Rx infection control and daily care products. The program also provides for dentures, extractions and emergency response to acute pain (certain rules apply; <click here for details>). We do so much more than just brush teeth.
Q: My Dad has dentures – does he need dental care?
A: Dentures harbor even more bacteria than natural teeth. Brushing dentures with regular toothpaste causes abrasion which leaves areas for bacteria to grow. We use special non-abrasive paste and ultra-sonic cleansing on dentures. When dentures are not cleaned thoroughly, the buildup can cause them to fit improperly. Poor fitting dentures often cause pain in eating and can also lead to an increase in harmful bacteria. Our monthly program includes fittings and relines for patients who have dentures.
Q: What do you mean when you say that your dental care is a preventative medical program?
A: Our monthly OHM® Program works toward preventing cavities, bacteria and infections in the mouth. Studies have shown that regular oral health can help prevent systemic diseases, such as diabetes, pneumonia and cardio-vascular disease. Proper oral hygiene can prevent hospitalizations and many additional healthcare costs. Good health starts with the mouth.
Q: Why is this dental care an insurance program?*
A: People who live in nursing homes have three choices to take care of their oral health needs. They can go through a Medicaid dental provider and get charged for every single service, including the cost of transportation. In this case, Medicaid may not cover certain procedures, including emergency services. Often it is difficult to find a dentist who accepts Medicaid. Secondly, the resident can choose to private-pay at a dentist of their choice. In this case each visit is billed along with each individual service. Often it is difficult to get to a dentist’s office and the bills can add up very quickly. Neither of these two options provides monthly service which is vital for overall health outcomes.
The other choice is to pay for dental insurance.* That’s what the PrevMED program offers exclusively through our partner, Senior Dental Insurance Solutions (in Georgia, Senior Dental Solutions). By paying a fixed monthly premium the resident will have our Dentist or RDH come to the nursing home every single month. For residents who are Medicaid-eligible this program may be 100% reimbursed.
The difference between ours and other insurance is that most insurance plans hope you don’t ever use the insurance. With our plan we WANT you to use the program…we are dedicated to SERVING EVERY PATIENT, EVERY MONTH.
*In Georgia the OHM® is a Health Care Program not an insurance plan. In Texas the Program is covered under a Health Care Plan with a guaranteed schedule of benefits. See the individual <State> information for details.
Q: I thought I heard you said it’s ‘free’, that there’s no cost for the program, but I am confused about the billing?
A: The PrevMED OHM© Program is available to all nursing home residents. For patients who are Medicaid-eligible, the OHM® Program may be fully reimbursed, resulting in no additional expense to the patient (or his/her Responsible Party).
How this works out for the patient (or Responsible Party) is that you will write two checks monthly – one to the nursing home and one to PrevMED’s billing partner, Group Benefit Services. However, the amount owed to the nursing home each month is reduced by the exact amount of PrevMED’s monthly premium. The nursing home is then reimbursed that amount by Medicaid. This results in no extra cost to the patient (or Responsible Party) and no-net cost to the nursing home.
Q: You say that Medicaid covers the cost of the program, but I think this is a strain on the system?
A: We have worked with dental experts to create a valuable, preventative health care program that can actually help save on downstream healthcare costs. The monthly cost of our program isles than half the cost if these services were billed individually by an outside dental provider. Our program is reviewed and approved by the Insurance Commission and our rates are based on federally-approved CDT code standards.