Medicaid: how it relates to dental care
Article Abstract:
An explanation is presented of how Medicaid, the federally funded program to provide health care to the poor, affects dental care. States that want to receive Medicaid funds must provide money for dental services to children; in general, Medicaid fees are lower than prevailing fees and rarely cover the costs of services. Practitioners cannot charge more for their services to Medicaid recipients than Medicaid pays. Dentists would like to increase the amount paid by Medicaid. Such a move has taken place in Kentucky, where automatic annual fee increases will occur beginning in 1992, and other state legislatures are attempting to change Medicaid services or reimbursement. Dental societies should resist attempts to link Medicaid participation to licensure requirements. Due to concerns that the poor receive less than adequate health care because Medicaid fees are so low, some states, such as Georgia, have proposed such moves. A discussion is also presented concerning insurance coverage for temporomandibular and craniomandibular joint disorders (disorders of the jaw joint). Ten states currently have laws that mandate insurance coverage for these conditions. The laws for each state are briefly explained and evaluated. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Journal of the American Dental Association
Subject: Health
ISSN: 0002-8177
Year: 1991
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A look at legal issues in managed care, marketplace change
Article Abstract:
Dentists must understand legal issues in the changing dental marketplace. Practitioners who decline to join managed care plans should honestly explain their rationale to inquiring patients. Lawsuits for defamation may be brought against dentists who fuel disparaging rumors about managed care companies. Tortious interference involves acts to undermine a business relationship between two parties, such as a relationship between a patient and a managed care company. Antitrust laws prohibit dentists who are not in the same group practice from discussing fees and fixing prices or initiating group boycotts. Managed care companies, integrated group practices, and merged dental practices are each considered single persons for antitrust purposes. Dental societies must obey the same laws as dentists. Dentists should carefully read and understand managed care contracts. Providers have a legal and ethical obligation to object to managed care treatment limits when they believe such treatment is necessary.
Publication Name: Journal of the American Dental Association
Subject: Health
ISSN: 0002-8177
Year: 1995
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Who's to blame?
Article Abstract:
Many managed care organizations can be held liable for adverse health care outcomes just as dentists can be sued for malpractice. They can be held liable for a dentist's misconduct if the managed care organization represents the dentist as their agent in their marketing literature. They can also be charged with corporate negligence by failing to recruit qualified dentists. Another example of corporate negligence would involve failing to cover a specific treatment for seriously ill patients.
Publication Name: Journal of the American Dental Association
Subject: Health
ISSN: 0002-8177
Year: 1997
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