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Insurer restores coverage to children's dental group

ATLANTA - A mobile dental practice serving 64,000 Georgia children, mostly from low-income families, is back in good graces with one of two HMO-like companies that had been poised to terminate its contract.

Officials with WellCare of Georgia announced Monday that the company will continue covering Medicaid and PeachCare enrollees served by Help a Child Smile, which operates 12 dental vans out of its office in Conyers.

The extension will cover 60 days beyond the expiration of the current contract Friday.

"Help a Child Smile is very excited we will be able to continue providing quality dental services at school sites throughout the state of Georgia without interruption and looks forward to reaching a long-term agreement with WellCare," Darryl Smith, the dental practice's group administrator, said in a prepared statement.

Early this month, WellCare and Peach State Health Plan, a second managed-care company hired by the state to run Georgia's Medicaid program, notified Help a Child Smile and another dental chain that serves mostly children that they would be terminating their contracts effective Friday.

Officials with Atlanta-based Kool Smiles held a news conference to complain that the move threatened to leave more than 70,000 of their 100,000 patients across the state without a dentist.

Then last week, 13 parents of children who are patients at Kool Smiles or Help a Child Smile filed a federal lawsuit challenging the terminations.

The insurers at first characterized the moves strictly as business decisions.

But last week, the state Department of Community Health, responding to the lawsuit, announced that the state is investigating complaints against Kool Smiles from parents and other dentists that it has been overutilizing some services and making too frequent use of patient restraints.

Kool Smiles officials shot back, accusing the state of trying to direct attention away from the terminations.

The decision by WellCare to extend its contract with Help a Child Smile will let 21,600 patients continue receiving dental coverage, Smith said.

He confirmed that Help a Child Smile also is working with representatives of Peach State to extend that contract as well, which would continue coverage for another 15,000 patients.

"We're cautiously optimistic," Smith said.

"We certainly left the door open to them," added David Bear, a spokesman for Peach State Health Plan. "They said, 'We'd like to try and find a way to continue this.' ... We told them we'd be willing to listen."

Meanwhile, WellCare released a statement Monday indicating that it has hundreds of dentists ready to accept patients who would be left without coverage by the termination of Kool Smiles.

"We have assured the state ... and all of our members that we have many times more dentists than needed near Kool Smiles offices who are ready, willing and able to treat our WellCare members," said Michael Cotton, chief operating officer of WellCare of Georgia.

One of the exhibits introduced in the lawsuit was a statement from an economic consultant that an "immediate and serious shortage" of dental care for children would occur in Georgia if Kool Smiles' contracts with the two insurers were terminated.