A Medicaid dental provider with multiple offices in the state contacted TDMR this past week, voicing serious concerns about recent restrictions imposed on their practice by Canadian-owned DMO DentaQuest regarding the use of substitute dentists.
Violation of Texas Administrative Code
According to the provider, DentaQuest denies substitute dentist requests unless the absence qualifies as a “leave of absence” per the company. This is despite the Texas Administrative Code (rules §354.1121 and §354.1221) explicitly permitting substitute dentists for absences of up to 90 days without specifying acceptable or unacceptable reasons.
DentaQuest representatives explicitly told the provider that substitute dentists should not be utilized for temporary coverage of short-term absences like emergencies, vacations or personal days. This hampers the practice’s ability to manage daily staffing shortages due to vacations, personal days, or unexpected call-ins.
DentaQuest already takes two weeks to review and approve such applications per the provider.
Treatment disruptions
The provider described significant operational disruptions, noting that one of their clinics had to close its doors to DentaQuest patients for an entire week due to a dentist’s scheduled vacation. DentaQuest refused to approve substitute coverage.
Furthermore, the two-week approval timeline for substitute dentists exacerbates emergency staffing situations, forcing offices to close temporarily if coverage cannot be promptly arranged.
Credentialing still broken
As TDMR has noted in numerous articles, credentialing is still a major issue. The provider told us that DentaQuest takes up to four months to credential new dentists and another month for providers to appear on DentaQuest’s online portal.
These delays prevent practices from performing pre-authorizations or submitting claims, further complicating operations, all to the detriment of Texas children.
Moreover, the provider noted that DentaQuest has closed credentialing in many locations across Texas, severely limiting staffing flexibility.
Foreign-owned company profiting at the expense of Texans
Again, should a foreign-owned company be in the position to make it difficult for Texas children to get their needed and approved healthcare coverage?
The answer is no.
DentaQuest enormous audits caused my practices to close and they filed charges with the OIG. this is happening all over the country and many dentists suffer for trying to help Medicaid patients get proper dental care.
I am not sure why the system is that bad. DentaQuest does those audits all over the country and ruins dentists. what to do?
I will tell you what to do. Stop taking Medicaid. I operate one of the most successful single doctor pedo practices in my area. The same thing happened to me. These people are evil. No two ways about it. As far as I am concerned, the entire system is evil. Here is how Medicaid dentistry should work: Dental students graduating with excessive debt (which is 75% of them), should be forced to work in government Medicaid dental clinics for 5 years to “pay back” their student debt. This is how Medicaid dental patients should be taken care of. No more stupid unfair audits of dentists who are TRYING TO DO A GOOD JOB. With this method, students get their debt paid off in 5 years. Then they are prepared financially to be able to purchase a dental office or start a dental office.
If you are a pedo office, start doing orthodontics. The American Orthodontic Society offers orthodontic classes for general dentists and pediatric dentists. Ortho is rewarding. Go to the American Orthodontic Society website and sign up for their BASIC STRAIGHT WIRE COURSE. It is on the order of $5K to $6K but it is well worth it and you will recoup your money quickly. I am sorry you had to go through this. Good luck.
Dr. W.
Thank you.
Unfortunately, dentists all over the country are subject to such unprofessional behavior by the monster DentaQuest. Dentists want to provide care for the Medicaid community and then get sued and penalized and have to fight DentaQuest for fake accusations in court to justify doing dental care. DentaQuest is known to do that all over the country and it seems that nobody can stop this.
They keep getting booted from states but settle in court and it can not be public information. the lawsuit keeps going and dentists are the ones who suffer from lawsuits, accusations, and unnecessary unlawful recoupments.
Thank you for your advice and will look into doing ortho work. Good luck to you as well.
DentaQuest’s last day in Massachusetts is March 31st . They harmed the state’s children by intentionally denying necessary care. I successfully sued to stop their behaviors numerous times. Good riddance to a “virtue signaling” monster. Care-Quest is another affiliated face of the monster….they certainly don’t “care.”