WellCare Assures Medicaid Members of Access to Quality Dentists
Kool Smiles Removed from Network - DCH Reviewing Allegations of
Over-utilization of Services, 'Unusual Patterns of Patient Restraint'
ATLANTA, Aug. 27 /PRNewswire/ -- WellCare of Georgia, Inc. announced today that it has confirmed hundreds of dentists in its network available to treat new patients. In fact, the WellCare dental network has the capacity to treat two-to-three times the number of patients who were seeing Kool Smiles dentists before WellCare terminated its contract with Kool Smiles. More than 90 dental practices within a five-mile radius of Kool Smiles offices have committed to welcoming new WellCare members as patients. In the Atlanta metro area, for instance, there are 15 offices eager to accept up to 46,000 new patients. "We have assured the state Department of Community Health 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. "Our network is extensive, and well beyond the access guidelines mandated by the state." WellCare has performed an analysis of claims data, which shows some startling facts. Kool Smiles treats primarily children and performs 17% more procedures per patient than other dentists. When compared with other dentists, a child treated by Kool Smiles is: -- five times more likely to receive crowns; -- four times more likely to receive five or more crowns; -- 40% more likely to have their teeth pulled or extracted; and -- three times more likely to be physically restrained during dental procedures. In addition, fourteen Kool Smiles patients under the age of ten have endured fourteen or more crowns placed in their mouth. While Kool Smiles was only about 5% of WellCare's dental network, Kool Smiles made up approximately 20% of general dentistry costs. Georgia's Department of Community Health (DCH) last week released a statement (attached) that the Department will "...thoroughly investigate all the allegations received from parents/guardians of patients and other dentists concerning poor care delivery received from Kool Smiles." The statement goes on to say that the DCH Inspector General began an audit of Kool Smiles back in March, and that it will also investigate concerns reported to them "... including but not limited to unusual patterns of patient restraint (such as use of restraining boards for children), over-utilization of stainless steel crowns in children compared to other dentists and normal averages, and lower use of preventive care (i.e. fewer sealants used to prevent cavities per patient treated) compared to other dentists." "It is a shame that Kool Smiles has been unnecessarily scaring our members about their access to dental care," said Cotton. "In the face of their well-orchestrated campaign of scare tactics, we could no longer sit quietly while our members and others were fed misinformation." A hotline has been established, in English and Spanish, and shared with all members who need assistance finding a new dental home. About WellCare Health Plans, Inc. WellCare Health Plans, Inc. provides managed care services exclusively for government-sponsored healthcare programs, focusing on Medicaid and Medicare. Headquartered in Tampa, Florida, WellCare offers a variety of Medicaid and Medicare plans, including health plans for families, children, the aged, blind and disabled and prescription drug plans, currently serving over 2.3 million members nationwide. For more information about WellCare, please visit the Company's Web site at http://www.wellcare.com.
SOURCE WellCare Health Plans, Inc.
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