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| COHI Letter-to-the- Editor Response |
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9/21/2007
To the Editor,
The comments of Dr. Martin Kane, President of Healthplex, regarding
oral health care for poor children were shocking.
Healthplex, a for-profit managed care company, just took over
management of Anthem Blue Cross' dental plan for poor children in the
State's HUSKY Medicaid program. It slashed reimbursement rates for a
Bolton dentist, a cut that would force her to drop 500 HUSKY children
from her care.
Dental rates for poor kids in HUSKY are so low that only about 100
dentists, out of more than 2,500 statewide, see HUSKY kids. More than
two-thirds of these children didn't see a dentist last year. Thousands
of these children suffer as a result with pain, missed school,
embarrassment and worse. In March a Maryland boy died because his
mother couldn't find a dentist for him in that state's program, which
has similar low rates.
The State is only paying about $8 per child per month in HUSKY while it
pays more than $22 per month for State employees' dental care. Yet Dr.
Kane says that if dentists on the Husky plan were "altruistic," they
would accept the Medicaid fee rates.
Incredibly Dr. Kane seems unaware of the impact of these extremely low
payments on poor children. In addition he apparently is also unaware
that the Legislature recently passed a $20M increase in dental rates
and the State is in negotiations to implement that increase.
State Department of Social Services Commissioner Michael Starkowski
should be applauded for acting quickly to reverse the Healthplex
action, citing the importance of access to oral health care for poor
children.
Blue Cross should re-examine its contract with Healthplex and choose a
vendor that shows more compassion for poor children who are suffering
without needed oral health care.
Marty Milkovic
Executive Director
Connecticut Oral Health Initiative (COHI)
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Oral Health for All
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September 22, 2007
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State Halts Reduction
in HUSKY Dental Payments |
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By Russell Vermilyea
09/05/2007
A complaint by a Bolton dentist has prompted the
state social services commissioner to suspend dental fee reductions
made by Anthem, an insurer in the state "Husky" health program.
Commissioner Michael P.
Starkowski on Tuesday ordered the suspension to gain time to evaluate
the fee changes, Matthew Barrett, a state Department of Social Services
spokesman, said today.
Starkowski said DSS, which administers the Husky
plan, found the reductions "poorly timed," considering that Gov. M.
Jodi Rell and the General Assembly had appropriated $20 million for the
plan with the purpose of raising dental fees to increase access for
patients, Barrett reported.
He said Anthem does not have to
gain DSS approval for fee reductions, but that Starkowski has authority
to suspend such actions, in this case because of the access issue.
Barrett said Starkowski does not want an insurer to "take steps that may impede access to care at this time."
He said only Anthem Blue Cross and Blue Shield is known to have reduced fee rates.
The complaint was filed by Ginger Pollack, who conducts a one-woman practice, Bolton Dental Group, at 665 Boston Turnpike.
In an e-mail Tuesday she said Healthplex of Uniondale, N.Y., an Anthem
subcontractor, rescinded her contract "because the utilization rate is
too high in an egregious attempt to unjustly enrich itself."
She said her practice is 99 percent Medicaid patients, and that a
"brief survey of providers revealed that my office was the only one being treated in this manner."
The Husky plan for
disadvantaged children and their families is financed through the state
and the federal Medicaid program for the poor and disabled.
Dr. Martin Kane, a dentist and Healthplex president, said by phone
Tuesday that Pollack is being paid at 120 percent of the Medicaid fee
rate and that WellPoint of Massachusetts, also a subcontractor, had
been paying at 200 percent or more.
"There is no way the plan is sustainable at what they were paying. ... It's not a bonanza" for dentists, he said.
He said if dentists on the Husky plan were "altruistic," they would accept the Medicaid fee rates.
Daniel Kaufman, chief financial officer of Pollack's practice, said
Tuesday that the Healthplex network manager visited the office Thursday
and said Medicaid fees on the state Husky plan would be reduced 50 to
80 percent.
"In effect," Kaufman said, the reduction would make "it impossible for her to see Medicaid patients," referring to Pollack.
As an example, he said, under the new fee schedule, a cleaning would be
$26, but 45 minutes to an hour are required for "a good cleaning," and
a dental hygienist makes $45 and hour. The previous fee for a cleaning
was $75, he said.
"They said accept it, or we'll find someone else," Kaufman said.
A cleaning on the Medicaid fee rate would be about $19, Healthplex Vice President Sharon Zelkind said Tuesday.
Pollack, Kaufman said, is still seeing Medicaid patients on the Husky medical insurance plan.
"She's got people in the middle of root canals," he said. "She's got to
treat them. It's a violation of professional ethics to stop."
Pollack has 500 Husky plan patients, he said. If the practice, which
has four employees, switches back to non-Medicaid insurers, Pollack
would "probably do some of it" referring to the Husky plan, "just to
feel she's doing something."
©Journal Inquirer 2007
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About COHI
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The
Connecticut Oral Health Initiative, or COHI for short, is a state-wide
collaborative of dental professionals, business and community leaders.
Our Mission is Oral Health for All. We work to persuade, educate
and inform decision makers and the general public about the important
issues involving oral health. We started in 1992 as a project of the
Connecticut State Dental Association and incorporated as a separate
501(c)(3) non-profit corporation in 2003. We are supported by your
tax-deductible contribution and grants from progressive foundations and
businesses.
175 Main Street
Hartford, CT 06106
860.246.2644
http://www.ctoralhealth.org
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