The Supreme Court of Iowa ruled in favor of appellee Robert F. Colwell, DDS, over the Iowa Department of Human Services in the Supreme Court of Iowa, No. 18-0464, on February 8, 2019, in a case that addressed the way denied claims may be appealed.
Colwell is a general dentist and credentialed dentist Medicaid provider in Iowa, practicing in Council Bluffs. When Iowa opted to expand dental Medicaid coverage to adult beneficiaries in 2014, Colwell elected to add this population and program to his practice.
Yet when Colwell filed his claims with the state’s Medicaid managed care organization (MCO), Delta Dental of Iowa, he says that the MCO unfairly withheld tens of thousands of dollars of his billed fees for dental services. He then filed internal appeals with Delta Dental of Iowa, to no avail, so he went to court.