TDMR received the following email from a Texas dentist. He has given permission for us to publish it and we are doing so anonymously to hopefully prevent any further retribution against himself and his practice.
I am writing this email to whoever might be able to help my patients. I am an oral surgeon in … and I have been treating Medicaid patients, both children and adults, for around 11 years. I have a current problem and I am not sure which route I need to travel in order to rectify that problem.
When Dentaquest and MCNA (as well as Delta) were awarded the Medicaid contracts in 2011 and started covering patients in 2012, my business partner and I were very active providers and provided care to a large number of patients in North Texas. When the new entities started covering patients, they brought with them rigorous changes as well. We went from a system which allowed us to treat patients using our medical judgment to a system that was based on cost savings. We understood that there would be changes, but the new system at that time did not provide for a system that allowed us to effectively treat patients. As such, we began to complain to the insurance entities in an effort to be able to provide treatment. The patients routinely were denied treatment that we had recommended being necessary. This went as far as to include denial of patients with emergent needs. When this occurred, we at first complained directly to the insurance providers, but as time wore on and we did not get anywhere, we eventually complained directly to Medicaid. Ultimately, MCNA elected to kick myself and my partner off of as providers despite the fact that we were treating hundreds of patients monthly.
We have continued on with Dentaquest since that time and have developed a middle ground where we are able to treat patients while operating within their parameters. For those patients with MCNA, they are forced to change providers in order to get treatment. This happens dozens of times every month as we are one of the only oral surgery providers in the DFW area and many of our patients come from long distances seeking care. Obviously, the changing of providers is an inconvenience for the Medicaid patients, not to mention a very inefficient way to deliver care.
In the interim, my partner and I have gone our separate ways and have maintained completely separate practices since 2013. He has managed to get back on with MCNA due to the fact that he now has a different practice name, but I am still blackballed. We have attempted multiple times to get back on with MCNA. We have attempted to have a sit down meeting with them in order to explain our position and how the current situation is an inconvenience for their patients. I have offered to fly to Florida to meet with the powers that be. We have been rebuffed at every turn.
The current situation makes little difference to my practice as I still see the same patients, but it is an inconvenience to my patients. Please let me know if you have any suggestions.
We have provided him a few suggestions.
It seems like talking to our self or to a wall when trying to communicate to the MCO\’s. The MCO do not answer and that is a common practice or better to name it in their own contract term, it is a \”pattern\’. MCO\’s shield them self with the contracts they elaborate. MCO\’s are business entities that do not care about the patients and less for the providers.
Either we all providers terminate the contract relations with the Medicaid MCO\’s for good or keep taking the arbitrary mandate from the MCO\’s until kicking all us out one by one when protesting and can not stand more arbitrary harassing acts as in the case presented. It has happen to me as well, I had proceed with all the protocols stated in the contract without answers from MCO\’s which end in a breach of contract situation from the MCO\’s end that still need to be address legally . It is not matter of one provider trying to change or conscience the MCO business people mentality to preserve our earned professional license dentist health providers right of practice.
MCO\’s Contracts sign are not other than giving away our legal providers rights earn with our dental license and at the same time with the contracts sign are talking away the patients rights.
The best way for we dentist to reform the Medicaid is a massive no reversible termination from the MCO\’S. We need to learn on how our predecessors took care of this kind issues situation from all days.
I did my contribution to this cause I am out of Medicaid. it is not easy but I wont be part of this disrespectful abusive harassing act against my profession and my personal values and morals. I do not became dentist to end up destroying our practice rights.
With out providers MCO\’s wont survive and no before we can set our own terms of the providers right of practice. The message is clear , Medicaid need providers and it is up to us to let MCO\’s to set the contracts terms and abuse us.