Almost three hundred seniors and patients with disabilities were stranded mid-treatment plan in Laredo thanks to a change in dental insurance providers in July of this year.
Since 2017, Dr. Amin Abdul of the Asclepius Dental Center of Laredo has provided dental care under Texas's Medicaid waiver coverage to disabled adults and the elderly, which provides an annual benefit to each qualified individual.
Molina/Liberty Dental coverage
The coverage is under the banner of Molina Healthcare but was provided by Liberty Dental. The Liberty plan, according to Dr. Abdul, provided excellent coverage with adequate fee reimbursement. Their plan paid $743 for a D5110 complete maxillary denture. Metal partials D5213 were $785, D5214 $829.
Change to DentaQuest
In June of this year, a patient informed Dr. Abdul that he had received a letter from Molina/Liberty that their coverage would change on July 1 from Liberty to DentaQuest. Dr. Abdul immediately contacted Molina and was told that nothing would change for him as a provider. He was skeptical, and he was right.
Poor changeover, no credentialling stranded patients
On July 1, 2021, his practice had almost 300 patients with active treatment plans under the Liberty dental coverage. When they started coming into the office for treatment after the deadline, their patient records could no longer be found in the Liberty portal.
Molina was contacted and they said to check DentaQuest's portal. Sure enough, the patient records were there...but Asclepius Dental Center and Dr. Abdul were not credentialed by DentaQuest for their plan!
Dr. Abdul told TDMR, "I, literally that same day, had patients coming to take impressions for their dentures after we had already taken out all their teeth. And now we needed to wait for weeks for credentialing!"
He could only apologize to his patients. He was told nothing was going to change, but everything was.
New fee schedule unviable
Two weeks later, Asclepius received the credentialing and also the coverage DentaQuest was now going to provide. It was radically different. Dr. Abdul was horrified.
He had scheduled a number of patients who had received implants under the Liberty plan to get dentures to connect to the implants. The DentaQuest plan did not cover anything to do with implants.
Some patients were scheduled for periodontal maintenance (D4910) four times a year, covered under the Liberty plan. DentaQuest didn't provide that coverage.
Dr. Abdul told TDMR that he found out that DentaQuest had instituted their own waiver coverage for Webb county and gave it a fee schedule not only lower than the previous Liberty fee schedule but even lower than DentaQuest's regular waiver fee schedule. A D5110 denture was now $656.20, D5213 $676.60, D5214 $676.60. Partial dentures, flexible, D5225 used to be covered at $893.00. Now they were $600.
These major changes stranded patients who had active treatment plans under the previous coverage. As Dr. Abdul did not treat his Medicaid patients differently in terms of care or quality of materials with dentures, this reduction of fee by DentaQuest made it impossible for him to provide treatment to these needy patients except at a huge loss.
"Take it or leave it"
The odd thing is that, per Liberty's website, it appears that Molina and Liberty still operate their dental program in other counties outside of Webb County.
Dr. Abdul has tried to get clarification and satisfaction from Molina and Liberty but to no avail. He was told it was out of their hands.
DentaQuest, despite the drop in fees by 35%, told him literally to "either take it or leave it. This is what we have. You want to take it, take it. You don't want to take it. It's up to you."
Well, he had to leave it. At the beginning of October, he informed DentaQuest he would no longer be a provider for the waiver plan.
Loss of coverage for most
As a result, almost three hundred seniors and disabled patients were now without a dentist in the midst of their treatment plans. According to Dr. Abdul, a few have been able to find other coverage. Some are finding money to make payments on their care. The majority are apparently out of luck.
Could this be the future of children's Medicaid in Texas?
DMOs radically shift coverages, rules, and rates to give the apparency of coverage, but make fees so low that practitioners can no longer provide service. Hence with a rising Medicaid eligible population, costs are kept down, pleasing state overlords while DMOs continue to profit from the capitation rates they receive.
Sad state of affairs, if true.