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09/05/2007
State halts reduction in dental insurance payment
By: Russell Vermilyea , Journal Inquirer
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In an e-mail Tuesday she said Healthplex of Uniondale, N.Y., an Anthem subcontractor, rescinded her contract "because the utilization rate is too high in an egregious attempt to unjustly enrich itself."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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