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Tennessean reporter investigates complaints over Medicaid dental provider Date: 07/18/14

Tom Wilemon
Tom Wilemon

By Mary Otto

Quite a few folks in Tennessee are upset right now with DentaQuest, the giant dental benefits company that took over the contract to provide oral health services to poor kids under the state’s Medicaid program earlier this year.

Two hundred black dentists are riled that they were cut from the provider network. The state dental association has withdrawn its support for DentaQuest’s contract. And some consumers (including a group home operator) are saying the company is making it harder for patients to get the care they need.

Meanwhile, company officials insist that no child with TennCare benefits has lost access to dental care under their watch. They defend their performance in Tennessee, saying that screenings have increased and that the state network of 864 providers – one for every 857 patients – exceeds nationally recommended standards.

What is going on? The Tennessean’s Tom Wilemon has been working to find out. His story last month, “Complaints Mount about TennCare Dental Provider” offered a look at the situation. In this Q&A, he gives an update and some additional insights into his reporting. He also shares some wisdom with others who might find themselves tackling a similar story.

Q: Some states are working very hard to attract new dentists to their Medicaid programs but in Tennessee, you write that dentists are being dropped from TennCare, the state’s Medicaid program. What have you been hearing from patients and dentists?

A: Dentists in Tennessee who were dropped by the new provider complain bitterly about agreeing to accept Medicaid years ago when this state did a push to get more into the program. They feel like no good deed goes unpunished because they thought there were operating according to business morals. The biggest complaint from patients are about having to switch to new dentists after having developed trust relationships with their old one.

Q: You’ve written that the recent troubles started brewing after the giant dental benefits company DentaQuest took over the state contract to provide dental services under TennCare. Can you tell us a little more about that contract? Does it signify a big change from the old one? Why are things different now?

A: The contract allows for an $8 million bonus to DentaQuest if it can reduce state costs. Critics say that’s why the company left dentists out of its network that saw large numbers of TennCare members. DentaQuest says the state shifted from from an administrative services-only contract to a partial risk-sharing contract.

Q: Some dentists have complained they think they were dropped from the network because they were seeing high numbers of Medicaid patients. Has DentaQuest offered its own explanation about why certain dentists were dropped?

A: The company said it evaluated dentists with higher-than-average claims denials and analyzed whether that was an indicator of performing unnecessary procedures. DentaQuest also looked at quality measures, such as the percentage of patients receiving fluoride treatments and the percentage of children getting sealants on their permanent molars. The company also said its contract required it to develop a new provider network.

Q: In your June story, you wrote that one dental practice in Nashville is asking federal court to intervene. Snodgrass-King Pediatric Dental Associates has sued DentaQuest and TennCare, but documents in the case are under seal. Can you tell us a little more about that case? Is there anything new since you last wrote about it?

A: The case is scheduled for a jury trial in January, but I cannot provide details because most of the filing, including the original complaints, are under seal. DentaQuest and the state have filed motions seeking that the suit be dismissed.

Q: Are you planning another story on this situation?

A: Not right now because there are a whole lot of other issues going on with TennCare, such as the state not having its own system for people to sign up for Medicaid. The state has also failed to set up a way for hospitals to do presumptive eligibility. Also the Medicaid expansion debate continues in Tennessee. Here are some of those stories:

Q: Can you offer a few words of wisdom to other reporters who suddenly find themselves trying to sort out a complex and emotional debate over Medicaid dental benefits in their state?

A: Cast a wide net. Do not forget to check court cases. (Hopefully, the files won’t be sealed in your state). Also, it is hard to draw conclusions when a contract is new. After time passes, you can actually check to see if patients are getting complicated dental care, not just check-up exams.