0

PeachCare managers dropping major children's dental firm

CHAMBLEE - More than 70,000 children in low-income Georgia families could lose dental coverage if two managed care companies drop a pediatric dental practice from their provider networks, an official with the practice said Monday.

But a spokeswoman for the Georgia Department of Community Health said no children will lose their dental benefits because of a "contract dispute" between dentists and the private companies hired to manage the state's Medicaid and PeachCare programs.

Atlanta-based Kool Smiles, which has been providing dental care to underserved children since 2002, has been notified that it will be dropped at the end of this month from the provider networks of WellCare and Peach State Health Plan.

Those two companies and a third managed care firm, Amerigroup, are paid a fixed fee each month for each Georgia Medicaid or PeachCare recipient they enroll under an initiative launched by Gov. Sonny Perdue last year.

The terminations are not for cause but rather are based on the companies' bottom lines, said Dr. David Strange, chief dental officer for Kool Smiles, which has 10 offices across Georgia, including one in Lilburn.

He said that without those patients, there's a good chance the practice will be forced to close, leaving those patients with no dental home.

"No one has ever said they have a problem with what we do clinically," Strange said during a news conference at the Kool Smiles office in Chamblee. "It's a business decision."

Strange accused the two companies of trying to save money by moving to limit access to dental care for low-income children.

But DCH spokeswoman Amanda Seals said Kool Smiles' patients will not be forced to go without dentists after the contract is terminated.

"They will be able to go to another dentist," she said. "We have staff that works daily with the (managed care companies) ... making sure there's enough of every area covered."

David Bear, a spokesman for Peach State Plan, characterized the decision to terminate the contract only as part of ongoing evaluations the company does to make sure it's using its resources efficiently.

He said Peach State has sent letters notifying all enrollees of the decision to terminate Kool Smiles and listing other dental providers.

"There's plenty of access to all of our members," he said.

But Strange said finding another dentist won't be as easy as either the state or Peach State Plan make it sound.

For example, he said losing Kool Smiles from Peach State's network would force every dental office within a four-mile radius of a Kool Smiles office to schedule five times as many appointments with Peach State Plan patients in order to pick up the slack.

"Every dentist in the network will have to expand services," he said.

Seals said the DCH has fielded a lot of phone calls from concerned parents about the termination. But she said her agency does not get involved in contract negotiations between providers and the companies the state hired to run the programs.