Ellie doesn't smile much.
It takes an hour into our first meeting before I see one. It starts shyly at her cheekbones, and then her eyes crinkle and her lips curve and it spreads across her teenage face like happy wildfire.
It's a gorgeous smile, or rather it almost is. It's a revealing smile, because when Ellie grins she can't hide her pain.
The problem is her teeth. When she smiles, you can see all of them, and you can see that many are twisted and broken and brown.
The 15-year-old been talking for an hour about the painful infections that rage in the molars and the cavities that form atop cavities and the sobering news that a dentist recently gave her.
If you keep these teeth, you are going to need more root canals, he said. Nine root canals.
The Bellevue West sophomore and her mother have been talking for an hour about the constant visits to the dentist's office since she was a toddler. The classmates who assume she doesn't brush or floss. They have been trying to explain the horror of the recent dentist's visit when they learned just how much fixing Ellie's problem would cost.
But it's when you see that smile that you really understand.
Ellie needs new teeth.
She needs new teeth, and those new teeth cost almost as much as a new BMW.
She needs new teeth, and insurance may not cover much of the bill, and there's no good Plan B.
There's no way around any of this.
“It just doesn't seem fair,” Ellie says.
My smartphone buzzed early one September morning. Suzanne Kolesik, Ellie's mother, had sent me an email. Not an ordinary email — a 1,500-word history of Ellie and her teeth.
It is a screed against the insurance companies and the cost of modern medicine. It is a plea for understanding. It is an email only a mother could send.
“A full mouth reconstruction (will) stop the infections and the pain forever,” she wrote. “She would have a smile that would only add to her wonderful personality.
“Imagine our utter disappointment when we were told this procedure would cost $50,000!”
When Ellie was a toddler, her mother noticed that her teeth were coming in strangely. They felt chalky. Flaky. Kool-Aid stained them for hours.
By Ellie's second birthday, Dr. Carmen Dana, an Omaha pediatric dentist, had diagnosed enamel hypoplasia, an absence of enamel on her teeth.
In most people, this lack of enamel happens on two teeth, or four. It's a minor nuisance. An inconvenience.
For Ellie, it meant twice-a-month trips to the dentist's office before she could talk. It meant the dental assistants wrapping her in a blanket so she couldn't squirm or run away.
It meant a whole lot of tears before kindergarten.
“I knew when it got bad, because she would just quit eating,” Suzanne says. “By the time she was 3, she knew what the area around Dr. Dana's office looked like. She would start to panic and cry when we pulled up.”
The silver lining turned out to be Dr. Dana herself. She treated her young patient so gently that Ellie started calling her “Auntie Dana.”
As the dental bills stacked up, Dr. Dana let Suzanne run a debt that sometimes ran into four figures. She never complained about the late payments. She never denied Ellie a procedure she knew the young girl needed.
But as Ellie got older, the money got tight, and she sometimes skipped dental appointments for months after she blew past the dollar amount of dental work that the family's insurance company would cover.
Every toothache worried her, because she knew that it probably meant another infection burrowing its way into a tooth. Dr. Dana put the strongest crowns she had on several teeth — and so many cavities formed underneath one of those crowns that the tooth began to rot and the crown fell off.
|Columnists Michael Kelly, Erin Grace and Matthew Hansen write about people, places and events around Omaha. Read more of their work here.|
By the time she entered junior high, Ellie had learned not to smile. She had learned not to smile because smiling showed her teeth, and showing her teeth meant the other kids would notice.
So you can understand her jubilation the day that Dr. Dana sent her to a cosmetic dentist, and that dentist sent her to an oral surgeon, and together they agreed that the next step was to get Ellie some new teeth.
First they would pull all of Ellie's old ones — goodbye brown, cavity-ridden teeth.
Then they would insert an implant on her top gum and another on her bottom gum. Finally, they would screw her new teeth into those implants, one by one.
All was fine until someone mentioned the price tag. And then the doctors mentioned that insurance companies often don't cover this procedure, as it is considered cosmetic.
Of course the doctors themselves don't consider it cosmetic. In fact, they have told Ellie and her mother that if they pull her teeth and then give her dentures — a far cheaper option — those dentures will grind on her jawbone until she needs further surgery as a middle-aged woman.
“I asked, 'If this was your child in this chair, what would you recommend?' ” Suzanne said. “And the answer back: 'I would go with the implants.'"
There is another issue: Is this a dental problem or a medical one?
The Kolesiks say it's a medical condition that happens to affect the teeth. Golden Rule Insurance Company, in its original denial, argues that the problem is dental, and the Kolesiks' health insurance therefore doesn't cover it. The implicit suggestion is that dental insurance should. Which would be fine, except that the Kolesiks' dental insurance pays out a maximum of $1,200 a year.
“Since the proposed services do not meet the plan requirements for coverage, no benefits are available for these services,” a rep from the health insurance company wrote in a letter to the family.
The Kolesiks are appealing. Suzanne just sent the insurance company letters written by both Dr. Dana and Ellie's childhood doctor. She also has written letters to the governor, the state's insurance board, her state senator and yours truly. Doctors have told the family that the appeal process sometimes works. Sometimes it doesn't.
As they wait, the costs are piling up.
The implants themselves cost $19,886, according to the original estimate, even after the oral surgeon gave the family a discount on his normal fee.
Actually pulling out the teeth — the part insurance is most likely to cover — is $5,800.
The prosthetic teeth are thousands more. Paying the dentist who puts in the prosthetic teeth is more still. The conventional dentures Ellie will wear for several months between the “full mouth extraction” and the placement of the prosthetic teeth that will be screwed into the implants cost even more.
Total tab: $47,000, give or take. That's the total despite discounts from several of Ellie's doctors.
The Kolesiks, whose total family income is around $50,000 a year, took out a loan to pay half the cost upfront. The other half will need to be paid in the next few months. They are hoping.
“In some way, I just don't care,” Suzanne says. “I want her to have this done. She needs to have this done. We'll figure it out somehow.”
They will need to, because today is the day Ellie goes to the oral surgeon. Today, he yanks out the teeth that have given her a lifetime of trouble.
Today is the day that Ellie has been awaiting for years. Today is the day that a mother hopes will change her daughter's life.
Today, Ellie takes the first step to a new smile.
“I want her to be able to eat without being afraid,” Suzanne says. “I want her to be confident. I want her to be happy.”