(The Center Square) — The House Joint Budget Committee grilled Department of Health officials over inadequate dental insurance coverage at a hearing on Friday.
The health department requested the state extend the contract with DentaQuest, a Louisiana dental insurance provider. The committee voted to defer the contract with DentaQuest until October, requesting more coverage data.
In many cases, Louisiana citizens have to drive 60 to 75 miles in order to find a dental practice that will be covered by DentaQuest, according to the committee.
“We have dental shortage areas in Louisiana,” said Kim Sullivan, the director of Medicaid for the Louisiana Health Department. “Throughout the state we have a shortage of general dentists and specialty dentists,” Sullivan pointed out, using the phrase “dental deserts.”
Rep. Charles Owen, R-Leesville, pointed to a history of service gaps from DentaQuest.
“We have had a lot of promises broken over the years,” Owen said. “Military retirees were told they’d get dental care for the rest of their lives, and the federal government pulled that out from under them. And now, to find out we have significant shortages, and our Medicaid population struggles to access this service.”
“They have to have an adequate network in order to meet the needs of the Medicaid population,” Sullivan said. “They get to determine how many providers they need in order to meet the population.”
In November 2023, the Legislature renewed DentaQuest’s contract with the state, but lawmakers had pointed out similar problems with lacking coverage and oversight on the reasons for the inadequacy.
“The issues that were brought to our attention last year suggested that there was not network adequacy, that there was a high level of rejection of claims, which caused the network to deflate because dentists did not want to provide services with DentaQuest because DentaQuest was denying so many claims,” Rep. Tony Bacala, R-Ascension, said.
Bacala recalled a DentaQuest representative promising to address the lack of service and that the plan was not working. The representative is no longer employed by DentaQuest.
“People who enroll with DentatQuest we’re not being afforded the services which they were entitled to,” Bacala said, flaming DentaQuest as a “bad actor.”
“The denial of a claim does not mean that service was not provided to a particular patient,” Southern Strategy’s DentaQuest representative Kevin Cunningham said. “What it means is that when a service had been provided, that it was not properly documented.”
“We serve as a liaison between your money and the service providers. In order for the state to be in compliance with CMS and LDH requirements, you need to make sure the claims are properly documented. You can’t do that after the fact, at the time the service was rendered we have to show that the proper documentation was in place,” Cunningham continued.
Bacala said that DentaQuest’s rejection rates were causing people to quit, further shrinking DentaQuest’s network of dentists which would provide coverage. The other firm which the state contracts with, MCNA, provided twice as many visits than DentaQuest, according to Bacala
Kevin Cunningham of Southern Strategy Group said the primary issue was a lack of oral surgeons accepting Medicaid in Lake Charles and Lafayette, though Dentaquest’s director of client management, Bridget Edwards, said this has been resolved.
Bacala continued to press the DentaQuest representatives to provide concrete data that shows that they have solved the lacking coverage.
Sullivan said that DentaQuest has improved their network adequacy and that there are no outstanding noncompliance issues, citing a July audit from the Louisiana Legislative Auditor.
