Does Kool Smiles Accept Medicaid

Date:

Kool Smiles Response To Cpi Frontline

Kool Smiles dental to pay $23.9 million, allegedly submitted false claims

Read the documents submitted to us by Kool Smiles in response to our reporting.

Within months, the states Medicaid dental director said she became alarmed when she saw a disproportionate spike in kids getting stainless-steel crowns to treat cavities coming from a number of dental offices. The state pays at least $230 for these shiny crowns, compared to as little as $100 for a filling. But their use is controversial to treat small cavities.

The state started requiring dentists to get prior approval for each crown. Thats when the state identified problems at Kool Smiles.

The X-rays didnt show a need for these kinds of services, said Donna Balaski, head of the state Medicaid dental program. What we tended to see was that there was a small cavity and they wanted to put a crown on it.

They also started reviewing Kool Smiless X-rays taken after the treatments and found problems that Balaski called atrocious: crowns that didnt fit, decay left untreated under a crown and nerves left exposed.

The state showed the X-rays to Kool Smiles at a meeting in August 2010 but Balaski said the company didnt seem to take the criticisms seriously.

As the weeks went by, the company failed to come up with a plan to deal with all the children with questionable care, according to Balaski. So the states Medicaid commissioner wrote a letter, telling Kool Smiles that some of the cases the state had seen were malpractice. Finally, the company started to respond, Balaski said.

Patients Left Searching For New Dentist After Kool Smiles Loses Medicaid Contract

We are in fact, the ones to inform her, Kool Smiles will soon no longer be accepting Medicaid. And she’s not alone.

“I was shocked because they actually just got switched over to PeachCare and so that’s why I made sure I brought them in today, because I didn’t know how the outcome was going to be,” says parent Melissa Riley,

Kool Smiles has about 100,000 patients across the state, 70,000 of which are on Medicaid or PeachCare. These patients will soon be forced to search for another dentist, becauseKool Smiles’ Medicaid contract has been terminated.

It’s Chief Dental Officer David Strange tells Newsleader Nine, ” We don’t know why we’re being terminated…but we will continue to fulfill our mission, vision and purpose.”

Meanwhile, patients will have other options. Drs. Henry and Cathy Cook operate one of the few local dental offices that accepts Medicaid and Peachcare. Founded by their father, the practice has been open more than 30 years, always with an open door.

“Overall, we just want to serve the patient population, no matter what type of insurance they have,” says Dr. Cathy Cook.

Good news for families like the Riley’s who’ll soon be searching for another dentist.

“I hope there is, because if not, I’ll be in a world of trouble,” says Riley.

Doctor Cook urges patients to contact the Georgia Dental Association or the local Health Department for a list of local dentists who accept Medicaid.

There should also be an 800-number to check with on the back of insurance cards.

What Treatments Are Covered By Medicaid

Depending on where you live, your child may be eligible for the following care under Medicaid:

  • Screening procedures to support dental health, including dental exams, screenings, tooth decay risk assessments, and x-rays.
  • General services to alleviate pain, halt infection, or restore dental health.
  • Preventative care, such as cleanings, sealants, and in some cases, fluoride treatments or space maintainers.
  • Therapeutic services, including fillings, crowns, root canals, and possibly microbial treatments to prevent the spread of tooth decay.
  • Other services that fall into the medically necessary category in combination with any of the treatments outlined above.

Did you know sealants on molar teeth can reduce the risk of cavities by 80%, according to the American Dental Association? Prevention works!

Don’t Miss: Qualified Health Plan Vs Medicaid

How Does Medicaid Work

More than 66 million Americans rely on Medicaid a joint federal and state program that provides insurance coverage for limited-income families .

Medicaid coverage isnt necessarily straightforward. Coverage can vary between states, and it can be difficult to figure out whether or not your family meets the limited-income requirements. Many people start the Medicaid application process only to find out that they make too much money to qualify for Medicaid and too little to pay for other types of insurance. Other programs, like CHIP, can help bridge the gap by providing low-cost coverage for children and families who arent eligible for Medicaid but cant afford costly insurance premiums. Like Medicaid, CHIP is a general healthcare insurance policy. It extends to dental care when the care is deemed medically necessary by the dental care provider.

Medicaid Fraud Allegations And Settlement

Are You Looking for a Local Dentist That Accepts Medicaid?

In 2012, Frontline aired a report saying that Kool Smiles inappropriately used crowns on young patients instead of regular fillings, because Medicaid bills more for crowns, and that the company pressured dentists to go along with the usage of crowns to make more money for the company. Kool Smiles responded by saying that, “Dentists do not receive revenue, patient or procedure targets or scorecards.” Kool Smiles pointed to a study authored by presidential economist Arthur Laffer, which reviewed Texas Medicaid claims data and concluded that, in 2011, Kool Smiles charged less and performed fewer procedures, including crowns, per patient than other Medicaid dental providers in the state. The company said, “Unfortunately, Frontline ignores what all dentists know â children with long-neglected dental needs require more medical care.” Later it was revealed Frontline had used a former employee as a source who was a convicted felon, who was suing the company after being terminated for allegedly falsifying documents. In response, Frontline acknowledged that their analysis showed that Kool Smiles provided 25% fewer crowns per patient than the average dentist, but maintained that “patients going to Kool Smiles were twice as likely on average to get crowns” in Virginia, and 50% more likely in Texas.

Recommended Reading: I Am Pregnant And Need To Apply For Medicaid

Dso Surpasses $128 Million In Uncompensated Care For The Uninsured

Posted By: GroupDentistryNowFebruary 14, 2018

Leading national childrens dental provider Kool Smiles recently announced its dentists have provided more than $128 million in uncompensated dental care to uninsured children and families since 2005. The Kool Smiles uncompensated dental care program has helped more than one million children and adults in 14 states and the District of Columbia access needed dental care in instances where private insurance or Medicaid did not cover the cost of care and families could not afford to pay out of pocket.

Ensuring that all children, regardless of insurance status, have access to high quality, affordable dental care is a crucial part of the Kool Smiles mission. While our doctors are proud to accept a wide variety of insurance plans including Medicaid, CHIP and TRICARE we also understand that sometimes insurance doesnt cover needed services and families cannot afford to pay. We believe it is our moral and professional duty to provide uncompensated care in these situations so all patients can get the treatments they need. Dr. Dale Mayfield, Chief Dental Officer for Kool Smiles

Read other Benevis stories on Group Dentistry Now HERE

What Is Kool Smiles Number

254-781-0553Call Kool Smiles Today If you need to speak to a dentist near you, call the Kool Smiles dentist phone number: 254-781-0553.

Does Medicaid cover braces?

The answer is yes! If braces are deemed medically necessary for your child, Medicaid can assist in getting them. This can be very convenient if youre looking into the cost of braces with Medicaid, CHIP, or TRICARE.

What age should a child go to the dentist for the first time?

The American Academy of Pediatric Dentistry recommends that a child go to the dentist by age 1 or within six months after the first tooth erupts. Primary teeth typically begin growing in around 6 months of age.

Recommended Reading: Therapists In Lansing Mi That Accept Medicaid

Q: How Can I Help My Child Learn Good Dental Care Habits

First, its important to supervise young children when they brush and floss their teeth twice a day. Ensure they are seen by a pediatric dentist around their first birthday, and that they receive regularly scheduled examinations and tooth cleanings every six months. Finally, browse our Kool Smiles collection of resources, including lesson plans and other educational materials.

Visit Different Our Partner Dentists Today

Kool Smiles Commercial

All our partners proudly accept patients with Medicaid but you dont need any type of coverage or insurance for your or your childs visit. Patients can choose to pay through cash, credit card, or CareCredit. Our partners also accept TRICARE and other forms of major insurance. For any questions regarding Medicaid, and its coverage, or how to set an appointment with our partner dentists, dont hesitate to give us a call. Our friendly team members are happy to guide you through all your different options for quality dental care

Don’t Miss: How To Get Approved For Medicaid In Florida

Why Choose A Kool Smiles Kids Club Partner

Kool Smiles Kids Club partners provide top-quality care. We have partners who offer orthodontic, endodontic, and pediatric services, so regardless of what type of care youre seeking for your child, weve got you covered.

Oral healthcare isnt limited to the dentists chair. Kool Smiles Kids Clubs partners know that healthy teeth start at home. Theyll take the time to teach your child good oral hygiene habits, including:

  • Proper brushing and flossing. Children should brush at least twice a day and floss once. Frequency isnt the only thing that matters, though! Our kid-friendly partners will take the time to explain proper brushing and flossing techniques.
  • Using a fluoride toothpaste. Fluoride toothpaste promotes healthy enamel and prevents tooth decay. It can upset the stomach if swallowed, so keep an eye on your child until theyre confident about brushing.
  • Limiting sugary foods and drinks. Kids love sugary treats, but sugar can damage the teeth. A dentist can help you understand how your child can keep a healthy smile by indulging in moderation.

Besides encouraging healthy habits at home, a Kool Smiles partner dentist will help your child feel at ease, so theyre less likely to fuss about going back to the dentist for routine checkups. A happy patient makes a happy dentist!

Kool Smiles To Pay $239 Million To Settle False Claims Act Allegations

Dentistry Today

    The Justice Department has settled False Claims Act allegations against Benevis LLC and more than 130 of its affiliated Kool Smiles dental clinics. Benevis and the clinics will pay the United States and participating states $23.9 million plus interest to resolve allegations that they knowingly submitted false claims for payment to state Medicaid programs for medically unnecessary dental services performed on children insured by Medicaid.

    Benevis and Kool Smiles noted that the settlement was voluntary and that it does not relate to any claims regarding the quality of the dental care provided to patients. They also said that it does not include any admission or determination of wrongdoing by the companies, their employees, or any Kool Smiles dentists. Additionally, the companies strongly disagree with the governments allegations.

    After a seven-year investigation, the United States alleged that between January 2009 and December 2011, Benevis and Kool Smiles clinics in 17 states knowingly submitted false claims to state Medicaid programs for medically unnecessary pulpotomies, tooth extractions, and stainless steel crowns, in addition to seeking payment for pulpotomies that were never performed.

    Related Articles

    Also Check: Dcbs Ky Medicaid Phone Number

    My Children Are All Really Young Do They Still Need To Go To A Dentist

    Absolutely. Anytime after their first birthday its recommended they start regular visits. Even when they still have their baby teeth they need consistent care to ensure their baby teeth help pave the way for their permanents to come in. Parents Magazine has a great article on how early care can help your child.

    How Can I Get Somebody To Explain My Medicaid Benefits To Me

    Find Dental Providers Who Take TRICARE

    If you feel like youre getting the runaround from your states Medicaid office, reach out to a team member at your nearest Kool Smiles partner clinic. Our partners deal with Medicaid every day and understand how it works. When you schedule a consultation, a team member will gladly explain your coverage and let you know what services are covered under your plan.

    Also Check: Medicaid Where’s My Ride

    Does Medicaid Cover My Childs Dentist

    Medicaid typically covers most dental care for children but finding a dentist who accepts Medicaid can pose a challenge.

    Planning ahead is generally a good policy when it comes to healthcare, and oral healthcare is no exception. Prepare for upcoming routine care and unexpected dental emergencies by finding out what services are covered and which nearby dentists accept Medicaid before your child needs to see a dentist.

    What Does Epsdt Mean When It Comes To My Kids Teeth

    EPSDT stands for Early and Periodic Screening, Diagnostic, and Treatment services. The goal of EPSDT is to catch issues early through periodic screening, perform appropriate diagnostic tests to assess the issues, and carry out timely treatment. The basis for EPSDT is that issues are typically easier to treat when theyre caught early, and outcomes are often better.

    Untreated dental problems are linked to:

    • Poor performance and excessive absences at school.
    • Psychological issues.
    • Preventable trips to the emergency room.
    • Increased costs

    Theres also evidence that oral infections may have some sort of relationship with other health problems, including heart issues and diabetes.

    Its worth noting that the P, or periodicity, in EPSDT can vary by state. Check with a representative from your states Medicaid office to find out how many visits theyll cover per period, and which services are included.

    Don’t Miss: Is Std Testing Covered By Medicaid

    Why Children Need To Visit The Dentist

    From that first baby tooth to the last adult tooth, children need routine dental care. The American Dental Association suggests children visit a dentist within six months of their first baby tooth appearing . Beyond that, the ADA recommends that children see a dentist for routine checkups every six months, so the dentist can:

    • Check for tooth decay or disease.
    • Carry out preventive fluoride cleanings.
    • Restore teeth to prevent tooth decay from getting worse.
    • Teach children and parents about healthy habits.

    Whether your child needs a routine exam or emergency dental treatment, rest assured that a Kool Smiles partner in your area will work with Medicaid to make it happen.

    How To Find A Dental Office That Accepts Your Medicaid Coverage

    An Inside Look at Kool Smiles – Working for Kool Smiles

    Kool Smiles Kids Club has partner dentists across the country who are committed to providing top-quality, affordable care for children. Kool Smiles partner dentists accept Medicaid, and they dont limit the number of Medicaid patients theyll see per day.

    Our partners also welcome patients with TRICARE, CHIP , and other major insurance plans. If youre uninsured or underinsured, Kool Smiles partners accept cash, credit, debit, and CareCredit.

    Also Check: Does Medicaid Pay For Partial Dentures

    Why Should You Choose An Experienced Pediatric Dentist

    Pediatric dentists have special experience putting nervous kids at ease while they care for their smiles and ensure their future oral health. With two to three years of specialized training in caring for children of all ages, a pediatric dentist can become a parents partner in ensuring great dental hygiene habits for life. Theyll explain the procedures to your child to eliminate surprises and help the child through the visit, and answer any questions you or your child might have afterwards.

    An experienced pediatric dentist can also help soothe any existing anxiety a child might have about visiting the dentist. Many have toys and a dedicated area for play to keep young patients entertained while they wait and will even allow parents into the treatment room to make sure the child is comfortable. They may also use either nitrous oxide or a local anaesthetic substance to minimize gum and tooth pain.

    Understanding Medicaid Laws For Dental Care

    Medicaid is a welcome relief for thousands of people seeking dental care. But it can also be confusing to keep all the facts straight.

    The information below is designed to help people better understand Medicaid laws as they pertain to dental care.

    Medicaid and Dental Care

    The first step in receiving the proper dental care through Medicaid is understanding how this type of insurance works and the options that are available.

    Dental care is covered for all eligible children.

    • Restoration of teeth
    • Maintenance of dental health
    • Relief of infections and pain

    However, if deemed medically necessary, all other dental services must also be covered under Medicaid according to the Early Periodic Screening, Diagnostic and Testing benefit.

    Adult Medicaid coverage varies depending on the state.

    While childrens dental needs are covered under Medicaid, adult dental coverage varies from state to state. Each state can decide if adults receive dental benefits, and there are no minimum requirements for adult coverage.

    Dentists dont have to accept Medicaid patients, no matter what state they practice in.

    It is up to each individual dentist to decide whether or not they wish to treat Medicaid patients. Because dentists receive a lower rate of reimbursement for Medicaid than they do for other forms of insurance, many dentists choose not to accept Medicaid patients.

    States must disclose a list of Medicaid providers.

    Recommended Reading: Who Is Eligible For Medicaid In Louisiana

    Affordable Payment Options With A Kool Smiles Partner Dentist

    Nationwide, around one in three dental offices accepts Medicaid. Of the dentists who do accept Medicaid, few see an unlimited number of Medicaid patients per day. Thats where Kool Smiles partner dentists comes in! When you choose a Kool Smiles Kids Club partner dentist for your childs dental care, you can rest assured that your childs health is a priority, regardless of which type of insurance coverage your family has.

    If youre not enrolled in Medicaid, but you think you might be eligible, visit the Medicaid.gov website.

    Popular

    More like this
    Related

    How Do I Find My Medicaid Number Online

    What If...

    Does Mayo Clinic Accept Medicaid

    Mayo Rebuffs...

    Does Medicaid Pay For Aba Therapy

    Making The...