Texas Health and Human Services has finally made an announcement about the award of DMO contracts for Texas Medicaid.
The announcement was posted on the HHS website yesterday and the big winners are MCNA, DentaQuest and newcomer United Healthcare Insurance Company.
HHS states:
"HHSC intends to award three dental managed care contracts to DentaQuest USA Insurance Company, Inc., MCNA Insurance Company, and United Healthcare Insurance Company for an initial contract period of three years. The award notices will be posted on the Electronic State Business Daily (ESBD) when the contracts are fully executed. That notice of award will trigger the period in which a protest may be filed in accordance with 1 T.A.C. §391.405.
"The statewide Dental Program provides dental services to over 3 million Texas Children’s Medicaid (Medicaid) and Children’s Health Insurance Program (CHIP) eligible children. The principal objective of the Dental Program is to provide quality, comprehensive dental services in a manner that improves the oral health of the Members through preventive care, health education, early intervention and to promote improved access to quality care, thereby significantly improving health outcomes for the target populations. Dental Members’ primary and preventive Medicaid and CHIP dental services are provided statewide through dental contractors. Each dental contractor is responsible for contracting with general dentists, pediatric dentists and dental specialists to create a delivery network."
The mystery is over.
Regardless which insurance company is selected to handle the Medicaid claims, the problem will still exist. Insurance companies want to make the diagnosis from radiographs, and as all real dentists know, a proper diagnosis requires clinical exam as well as good radiographs. Also when a Medicaid child presents with pain and a situation which needs to be treated ASAP, it is impossible because a prior authorization is required if the dentist wants to receive payment for his skills and knowledge. Yes, I know these things have been put in place to help deter fraud, ,and the insurance companies use these tools to make more money. Until the diagnosis and treatment is put back in the hands of the doctors, nothing will improve.
I do believe fraud should not go unchecked, but the insurance companies as well as the doctors must be held liable.