Dental Providers Riled Up About DentaQuest Capitation Payment Plan

TDMR has received an email from a group calling itself “Texas Dentists for Fairness.” Per their email, they are a group of owners of individual clinics from around the state  Other than that we don’t know anything about them.  They are tremendously concerned by DentaQuest’s “private conversations with some of the largest DSO servicing Medicaid in Texas…regarding DentaQuests desire to move to a CAPITATION model” and that they will be left powerless and in the dark by any such plan.

Their concerns are eloquently outlined in the email which is reprinted in full below and we would appreciate any provider comment.  Please reach us at

Texas Dentists For Medicaid Reform,

                           We are reaching out to you in an attempt to shed light on an injustice that is in the process of unfolding in the State of Texas.  As you are already aware, DentaQuest, the Massachusetts based Healthcare giant, that has been servicing the Texas Dental Medicaid program for the last 6 years is currently vying to renew their contract with the State.  What you may or may not know is that DentaQuest has been having private conversations with some of the largest DSO servicing Medicaid in Texas. These conversations have been regarding DentaQuests desire to move to a CAPITATION model. The model would include per patient, per month payments of 25-35$ to take care of all the patients’ needs.  We were told by our friends who attended these meetings, that they have been promised to have their offices “flooded” with patient assignments in return for acceptance of the program early.  Those that have not been receptive to accepting the plan have been the target of veiled threats that included but are not limited to Corrective action plans, a freezing of patient assignments, and refusal to grant a DentaQuest Medicaid number in any new practice.

                          We are a group of individual clinic owners and we have been left in the dark about these plans.  DentaQuest is effectively shutting off our ability to register new Associates or open a new practice. The most alarming fact is that DentaQuest itself owns many practices in Texas and have created and are planning to grow a VERTICAL INTEGRATION model in which they own the clinics and the Insurance.   They can funnel assignments towards their own clinics and those aligned with their goals and take away the freedom of choice from patients by limiting office registrations and restricting patient movement.  Guardian was taken out of the running to become an MCO precisely for this reason, so why is DentaQuest allowed to stay?  [NOTE: TDMR was contacted by a representative of Guardian Life Insurance who told TDMR that this statement is not true. Guardian was not taken out of the running.]

                            The Office of the Inspector General filed a report on DentaQuest’s failure to properly investigate fraud, waste and abuse among the providers. They have performed very little oversight and routinely offer statistics that seem to have no basis in reality in their reports.  The Capitation model seems to be their solution to not providing oversight because the providers no longer bill out services. They just collect capitation payments and make money by limiting access or upselling a population that lives largely below the poverty line.  DentaQuest meantime gets to greatly reduce overhead because it no longer has to process claims, provide oversight, or do many of the administrative tasks that the State pays and expects it to do. This is an injustice and one of the worst examples of corporate greed we can remember.

                          We have no real voice and are frankly afraid of retribution. We need the leaders in our State such as yourselves to be the voice of voiceless. I am sure the DSO’s can afford to be on any plan they choose and survive. They may even strike deals with DentaQuest that help them increase revenue. The small providers like us will not be able to survive, and DentaQuest will be there to buy up our struggling practices to gain a bigger market share and better vertical integration.  In the meantime, it will be the children who suffer.  Assigned to practices they do not want to go to and who have incentive to do as little work as possible. We fear there will be a huge spike in emergency room visits, and children suffering. Please be the voice of the voiceless, ours and theirs. We only desire a level playing field where we can provide quality of care to the patients we have seen for so many years. We wish to get paid a fair wage for the work and the procedures we do. Please help us by bringing to light this issue that is lurking in the shadows right now.

Thank you so much,

Texas Dentists For Fairness








2 Responses

  • This is exactly what happened in Oregon and what is in the process of happening in Washington. Closed door talks, behind the scenes planning, and the majority of providers find out after the fact. They hit the nail on the head about the vertical integration model. Oregon Advantage Dental insurance and clinics is a perfect example of this as they have bought up more and more practices to consolidate their foothold. I hope Texas can fight this and stop this corrupt private/public monopoly from taking over.

  • Good luck, Texas Dentists for Fairness. That said, there hasn’t been anything “fair” about state contracting since maybe ever. The DSO’s and DMO’s have more influence and political strength and they will use it to grow their piece of government provided income. Sadly, Medicaid really ends up being about who gets the big money – recipients are merely the conduit.

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