In response to TDMR’s latest story on payment holds placed on Medicaid dentists by MCNA, TDMR received an emotional missive from a Medicaid dentist about his negative experience with MCNA. He gave permission to publish his comments.
The legislative session is starting and we will do our best to inform legislators about such issues.
If you have a similar experience, please don’t hold back. Let us know.
Here is what he had to say:
MCNA is withholding more providers than they will admit. Based on my experience with them, MCNA is not treating the hard working providers fairly. They are falsely accusing these doctors of fraud and other infractions which have no merit. They are illegally withholding payments, even when the doctors prove their treatments were completed as claimed.
Young cancer patient left with severe dental problems approved for treatment
For example, I have a patient who was recovering from years of complicated cancer treatments,which left her dentally handicapped. Her lower jaw had been resected and many teeth had either been lost or severely damaged due to inability to do daily oral hygiene for long lengths of time. After extensive oral hygiene instruction and many hours of planning with all the diagnostic tools; X-rays, models, intraoral pictures, preauthorization of all planned treatment, MCNA approved all of these”medically necessary” treatments.
MCNA secretly recoups payments – “changed their minds” on approval
After months of treatments and being close to completion of planned treatments, MCNA silently began to “recoup” the payments already paid on completed treatments from my bank account. When my business manager noticed these recoupments, she promptly called MCNA to ask what was going on. They told her that they “changed” their mind and “reversed” the pre-authorizations.
MCNA stops paying for child’s routine cleanings
After months of “reproving” the “medical” necessity, and getting many sympathetic comments from MCNA employees, they upheld their recoupments AND stopped paying on all the other pre-approved treatments of over 17 crowns and a partial denture. Even the following routine cleanings and check-ups were unpaid.
Dentist wonders why he does this
Like most sincerely committed Texas Medicaid dentists, I continued to treat and follow up with this brave little patient. After all, I thought she had already been through so much, it’s not her fault that the Texas Medicaid system doesn’t care about her. I do! I care! I have been practicing in Texas for over 40 years. Even before Medicaid was ” invented,” I was providing the needy in my community with the dental care they couldn’t get anywhere else at little or most of the time ” no cost.”
Many, many times, I asked myself, ” why am I doing this for so many patients”? Even during very hard times, I still continued to do it. When I asked my “dental friends” if they felt the same way, about 10% said yes and the others either laughed at me or said I shouldn’t do it.
Now the plot thickens.
MCNA stopped paying for all dentist’s patients
When we asked MCNA what recourse, we had they stopped communicating with us. They stopped paying on any of our MCNA patients.
Texas Medicaid officials provide no help
When we contacted our Texas Medicaid representatives they said we had to completely exhaust ALL avenues with MCNA before they could help us! So we asked MCNA to hear us out. They said we would have to go to Florida to state our case!
Supposed to go to Florida for an MCNA hearing!
I couldn’t believe it. Our Texas Medicaid program wants to adjudicate me in Florida!
I need help! I’m like Mr. Trump, I’m fed up! Our government doesn’t care. The Texas Dental Association doesn’t care.