U.S. lawmaker asks companies to answer for poor oral care access

Concerned about “troubling” insurance practices that curb and discourage dentists from accepting patients with Medicaid, a U.S. lawmaker has asked companies that administer dental benefits in Illinois about solutions for breaking down barriers to oral healthcare for Medicaid enrollees.  

Recently, U.S. Sen. Dick Durbin (D-IL) sent oversight letters to DentaQuest, Envolve, and Avesis, all dental benefit administrators for Medicaid managed care companies, seeking answers to the challenges that Medicaid recipients face accessing oral healthcare. The barriers lead to beneficiaries, specifically children and people with disabilities, facing long waits for necessary treatment, Durbin said in a press release dated November 15.    

Other factors, including limitations on appointment length, reimbursement time limits, and prior authorization requirements, also are common and prevent dental care providers from being sufficiently reimbursed. These factors contribute to patients being placed on waiting lists that exceed one year or more to receive specialized treatment, including dental surgery under anesthesia, according to the release.

When companies create these barriers, they prevent Medicaid beneficiaries from receiving essential care that may circumvent more serious problems in the future. With all of these factors in mind, Durbin asked the companies about credentialing dental care providers, approving treatment claims, and coverage for dental surgeries.

“If oral health providers -- already facing challenging reimbursement rates -- are forced to jump through burdensome, unjustified bureaucratic hurdles to furnish care and obtain timely reimbursement, patients suffer,” Durbin wrote.