The Solution To Texas’ Dental Medicaid Problems

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Grandma’s Self-Insured Dental Plan 

By Darrell Pruitt, DDS

As I read your political call for dentists to help expand Medicaid/Medicare dentalcare, currently administered by DentaQuest, it occurred to me that taxpayers deserve more transparency concerning DentaQuest – an increasingly popular but secretive destiny for tax dollars.”

Transparency: The solution to Texas’ dental Medicaid problems

If the name Dr. John Luther sounds familiar, a decade ago, while serving as ADA Senior Vice President, Dental Practice/Professional Affairs, Dr. Luther successfully persuaded tens of thousands of trusting members to volunteer for permanent HIPAA NPI numbers – without ever having to say why. He is that good.

Today, Dr. Luther posted “What’s next for Medicaid and Medicare when it comes to dental benefits? – Access to dental care should not be a function of age or income. We cannot rest on the achievements made for children’s oral health. We must continually strive for oral health equity for all [especially DentaQuest].”

http://www.dentistryiq.com/articles/2015/07/what-s-next-for-medicaid-and-medicare-when-it-comes-to-dental-benefits.html

My response:

Dear Dr. John Luther, Chief Dental Officer for DentaQuest:

As I read your political call for dentists to help expand Medicaid/Medicare dentalcare, currently administered by DentaQuest, it occurred to me that taxpayers deserve more transparency concerning DentaQuest – an increasingly popular but secretive destiny for tax dollars.

As you know, DentaQuest, which administers Texas’ dental Medicaid program, recently notified participating dentists that they will not receive payment for providing sealants to Medicaid patients unless photographic evidence of the need for sealants is provided. As Chief Dental Officer, when you approved the idea, did you fail to recognize that the costly, senseless demand on dental practices is certain to result in fewer Medicaid patients benefiting from the proven protection of sealants?

To laypeople – and apparently to dentists whom DentaQuest turn to for advice – photographic proof of grooves in molars might seem like a reasonable, cost-saving requirement. However, in the real world, dentists, hygienists and assistants who must obtain such documentation easily recognize the waste: Not only does it cost additional time and money to “document the medical necessity for sealants” (a dental procedure which already offers little or no profit for Medicaid providers) but NOBODY can accurately determine the need for sealants from even the best photographs of sometimes-squirmy kids’ teeth. For one thing, some sealants are virtually invisible. Nevertheless, on June 29, Brenda Walker, Provider Relations Manager for DentaQuest, sent the following letter to participating Medicaid dentists in Texas:

RE: Information on Dental Sealant (D1351 and D1352) Benefit- Update

Dear Dentist:

One of the preventive measures DentaQuest supports and encourages is the use of dental sealants on appropriate teeth and surfaces. The AAPD Periodicity table supports the use of sealants on posterior primary and permanent teeth only. Effective 08/01/15 the review requirements for D1351 and D1352 dental sealants will be according to [“Texas Medicaid Child” tables].

Pre-Payment Review involves dental procedures that require review by DentaQuest for determination of medical necessity prior to reimbursement for the procedures. These procedures can be administered before determination of medical necessity is rendered but require submission of proper documentation for approval to process the claim.

The required documentation will include a narrative and receipt of an intraoral photograph evidencing the medical necessity [of sealants]. This photo must be taken inside the mouth and does not have to be with an intraoral camera. Participating Providers will not be paid if the required documentation is not provided or medical necessity is not demonstrated.

DentaQuest requests your support with the appropriate utilization of dental sealants. With your help, we can reduce the incidence of decay in children and keep them healthy and smiling. Should you have any questions, please contact our Provider Services Hotline at 1.800.896.2374.

Sincerely,

Brenda Walker

Provider Relations Manager.

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Note that Ms. Walker assures dentists that intraoral cameras are not needed for the intraoral photos required by Medicaid. This openly suggests the quality of the images is less important to DentaQuest examiners than the dentists’ documented effort to acquire them. I suspect DentaQuest never intended to examine the blurry, poorly-lit, expensive photos.

Dr. Luther, there are taxpayers in this DentistryIQ audience and elsewhere who believe you are promoting senseless, expensive busywork in Texas for the benefit of DentaQuest – regardless who gets hurt. It seems apparent to me that children from poor families in Texas are due to suffer preventable toothaches due to corporate greed. As Chief Dental Officer, are you accountable?

D. Kellus Pruitt DDS

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