UPDATE: We published this story back on September 12 last year about a provider quitting MCNA in disgust over a $33,000 recoupment demand.
This provider added a comment on this story last week which we want to highlight as he has now quit DentaQuest for similar reasons and dropped out of Texas Medicaid.
It is a sad story for needy children and highlights our recent survey results that show the increasing dissatisfaction of Medicaid dentists with Medicaid.
"It has been a while since I visited this page. Yes, we did get an attorney involved. Unfortunately, the outcome from Dentaquest (as yet) is “We are Judge, Jury and Executioner”. We terminated our contract with Dentaquest and Medicaid as a whole.
"It is extremely unfortunate as we have seen some of these patients since they were 6 months old and have witnessed them grow into young adults. In this area, there aren’t too many Medicaid providers, but that has never been the concern of the MCO’s. Our Dr’s. have had enough of someone sitting behind a desk, who doesn’t have a dental or medical degree, who do not have the patients best interest at heart and perhaps never looked down an oral cavity, other than their own, dictate how we practice dentistry.
"They have never worked on a four-year-old screaming bloody murder while working on a filling and for them to quote “it isn’t good dental practice to do a filling on a baby tooth”. Just let it rot in the kid's mouth! It will eventually fall out!
"Wisdom teeth have to be approved, we all know that and have had every single one approved. The approval letter is toilet paper and we all know what to do with that!
"Dentaquest states even though we approved a D7240 we will downgrade to a D7210 and recoup the difference. These procedures were completed in 2016 and 2017 and supposedly approved by a licensed dentist at Dentaquest.
"If the pre auths were approved by a licensed dentist, then the audits have to be done by a blind janitor. Look at the pano’s for crying out loud!! The tooth is completely under bone!
"For those of you who are still running this rat race. I have the utmost respect and sympathy. We wish you luck in navigating this game with every changing rules."
From time to time, TDMR receives correspondence from dentists expressing their frustration and anger with one or both of the current DMOs managing Texas Medicaid.
Last week, we received an email from a dental provider about a recoupment demand made by MCNA. Apparently, it took the company three years to review the documents he had sent them per their initial request. He has agreed to let us publish his email.
He also let us know that he has just sent MCNA a letter informing them that he has voluntarily terminated his participation. He said that "I know several others who have been tortured by this MCO. It's like we don't have a say. They are a law unto themselves."
Here is what he told us.
I received a letter from MCNA informing me that they have completed a review of records I submitted over three years ago.
Strangely, they're recouping over $33,000 of payments made for all the procedures in the records I sent them.
Some of the reasons given were "no exams was done because note says patient present with parent for treatment". Others were there was no radiographic evidence of decay on occlusal! The list goes on and on.
Don't we as clinicians have any right? How can we allow these people to destroy us?
It is our usual policy to ask the DMO representatives for their comment on such situations before publishing. However, MCNA hasn't responded to our last few emails so we did not bother.
Complaints to HHS about DMOs
Last year, we informed readers that there is a person in HHS to whom provider complaints about DMOs can be addressed. This is Marguerite Laccabue, Dental Director at Texas Health and Human Services Commission, Medicaid and CHIP Division.
Her contact information is:
There is also the Managed Care Complaints email address.
Managed Care Inquiries and Complaints Mailbox
Does anyone want to complain in person?
Well, there is a State Medicaid Managed Care Advisory Committee meeting next week in Austin. The public is invited and there is a public comment section on the agenda.
Here are the details:
September 12, 2018 - 10:00am
This meeting will be webcast. To access the webcast, go to https://hhs.texas.gov/about-hhs/communications-events/live-archived-meetings the day and time of the meeting.
- Call to order
- Roll call
- Adoption of June 18, 2018, draft minutes
- Re-adoption of Committee Bylaws
- Health and Human Services Commission (HHSC) procurement processes
- Managed care oversight initiatives
- Subcommittee reports:
- Subcommittee on Goal 1 (Provide HHSC leadership with an accurate and balanced view of both challenges and opportunities identified in the Medicaid managed care delivery system, and offer innovative and operationally practical solutions)
- Subcommittee on Goal 2 (Develop sound recommendations that directly affect Medicaid managed care clients by prioritizing quality health outcomes, patient safety, and fiscal responsibility in the delivery of programs and services)
- Subcommittee on Goal 3 (Advise HHSC on activities related to ensuring clients or members are receiving timely care coordination for medically and functionally necessary services across all Medicaid managed care programs. This will include recommendations for continuous collaborative communication between HHSC, managed care organizations, members, and providers, as well as for the rapid resolution of eligibility and enrollment issues)
- Vote on committee recommendations to the HHSC Executive Commissioner
- Expiring member terms
- Committee report to the HHSC Executive Commissioner
- Report content
- Public comment
Contact: Questions regarding agenda items, content, or meeting arrangements should be directed to Becky Alejandro, Health and Human Services Commission, 512-462-6334, or Rebecca.email@example.com.
This meeting is open to the public. No reservations are required, and there is no cost to attend this meeting.
People with disabilities who wish to attend the meeting and require auxiliary aids or services should contact Alejandro at 512-462-6334 at least 72 hours before the meeting so appropriate arrangements can be made.