We have closed our revised 2018 Dental Management Organization annual survey and are today giving you the results. Our survey sample is not that large, unfortunately. At the end of the day, only 39 providers entered the survey as we decided to ask for actual names and provider numbers to prevent possible false responses. Consequently, it is more than likely that those providers with problems took the time to answer the survey than those that had few or none. Please keep in mind this is a casual survey and not in any way scientific.
That being said, the results seem to reflect the reality of the current situation for dental Medicaid providers.
Results changed from 2017
Our last survey done in 2017 showed that dental providers were dissatisfied with both DentaQuest and MCNA but more so with MCNA. After all, MCNA had been placing payment holds on providers which they had no authority to do. For 2018, while the number of providers still thinking MCNA is “terrible” remains higher than DentaQuest, it is significantly less than last year. The majority of providers have “lots of difficulties still encountered” with MCNA and the number of those for DentaQuest has increased significantly.
A good note is that there was a slight rise for both companies in those providers finding “there was some improvement but still not satisfied” over last year.
Problems still abound
The problems that providers reported having with each company have changed somewhat.
With MCNA in 2017, the largest reported problem was “not approving medically necessary treatment.” Thankfully, that concern has dropped significantly this year. It has been replaced by “dictating treatment against my judgment.” which was also reported as significant in 2017. The second largest reported problem in 2018 with MCNA is “credentialing takes a long time.”
DentaQuest’s largest reported problem in 2017 was “dental homes keep switching.” For 2018, this is still the second most important problem encountered with the company. However, concerns about the company “dictating treatment against my judgment” have grown significantly over the past year to become the number one problem encountered.
As far as the severity of these problems is concerned, both providers still have “multiple minor issues that don’t get resolved and keep recurring” as the most popular response. For MCNA, the second most popular answer still is “a serious issue(s) that I cannot get resolved and is still outstanding.” DentaQuest has “multiple minor issues that don’t get resolved and keep recurring” as the second most popular response which increased significantly from the year before. More importantly, the number of respondents reporting “no problems at all” with DentaQuest dropped drastically from 2017 to 2018 from 24% to 4%.
A significant number don’t want a new DMO in Texas
As the RFP for the Medicaid dental contract has now gone out, it is significant that 35% of those responding did not want to see a third DMO in Texas. From conversations with providers, it appears that for some the anticipated complications and probable administrative difficulties in accommodating a third company into the market out-weighs any possible benefit they might receive.
Majority providers report being “frustrated”
When asked about their attitude as a Medicaid provider, there is a definite difference from 2017. While no one reported being “very happy” in 2018, the level of satisfaction grew by roughly 10% from the previous year. Perhaps the almost 10% who reported being “very happy” in 2017 have downgraded to “satisfied.” The most popular response this year was “frustrated,” replacing “worried” as the number one answer. Those “very upset” have also grown by 10% from the year before. Those “on the verge of quitting” went up by 5%.
Again, our sample may be skewed towards dissatisfaction as stated above.
There you have it, our 2018 survey results. You can review and download these below.
DentaQuest has changed the time from 12 months to 36 months that they will pay for same tooth restoration by same dentist.
The policy in full states:
replacement of an identical restorative service in less than 36 months by the same office is not considered the standard of care for quality by DentaQuest. Ifthere are special circumstances requiring this repeat service, please send in a prior authorization request along with a narrative establishing medical necessity.
They also denied a prior authorization for a filling on the same tooth but a different surface. Original treatment MO then 1 year later there was decay on distal and I requested payment for an MOD with a narrative and it was still denied because of the above rule. I called to explain it was a different surface and new decay and I was read the policy like I was a child that did not understand. So do I treat the patient using time, energy and money for free or leave the decay?
HMO are there to delay and to denied . So the budget will not exceed Medicaid federal allowances.
This HMO do not care about patients just to keep their contracts and fill their pockets with $$ at providers work no paid treatments.
Dentaquest is a lot worse in the last one year. Did a lot marketing and somewhat incentives but add a lot of paperwork to delay the treatment. Leaving the kids hurt. Be aware that also take the cases they already paid back so you work for free. Way to save money, well, I hope not for bonus.
Dentaquest refuses to do a build up on a tooth that already had a cap. Even though it was caused by the dentist who did not put the cap on correctly in the first place.
Don’t bother billing building build ups, permanent crowns, or even 3 surface fillings. Why? they pay 50 bucks and you can get 100 or so if you bill (and do) a filling instead. Never do a permanent crown at 276 bucks total reimbursement when you can get 150 for a stainless steel crown, no impression or return visit. Lab costs are 100 on the permanent crown, and only 5 bucks on SSC and then no risk that historically unpredictable medicaid patients won’t come back to have the final permanent crown seated. I could cut costs by sending the perm crown to china…29 bucks, god only knows what they put in the crown.
For those that don’t know, you don’t get paid unless you seat the final crown, and medicaid patients fail at least 50% of their appointments even if you confirm 10 day, 2 day, 1 day, 1 hr, and 1 minute ahead of time. Hard to remember appointments apparently. So if you do a permanent crown, not only do you barely cover your lab and other hard costs, you can only seat half your crowns due to compliance, so you really get screwed if you like doing decent quality work. Also crowns don’t fit very well due to tooth shifting after 1-2 years when the patient finally waltzes back into the office and expects their permanent crown to fit even though the temporary has been off for the last 6 months. (teeth shift a lot and quickly when there is no temporary on)
Now fillings: 2 surface composites pay MORE than 3 surface posterior fillings. Why would anyone do a 3 surface? for the life of me, I can’t figure it out. Perhaps medicaid could explain it to me.
Extractions: you have a kid in your chair in tears from bombed out permanent tooth. As a provider you are caught in the horrible position of either 1: doing the extraction whether or not medicaid pays or not. They will then usually deny the claim because it wasn’t preauthorized and then you just did free work. 2: you let the kid leave in tears while your biller preauthorizes a 96 dollar surgical extraction (normal office fee that EVERY ADULT PAYS for this same service is around 290.00, so the government is getting a heck of a deal anyways, and I don’t get paid for the pain of doing the preauthorization). Alternatively I could do an extraction and bill a lower code…d7140 and get 30 bucks. At least enough to cover the anesthetic and the room setup etc. So 90% off my standard rate. Lovely choices.
They refuse to provide a number where a doctor can call a doctor directly for emergency authorizations. Probably too expensive for them (medicaid).