How is Doral Dental doing with MassHealth members?

June 16, 2008 - 10:28am - Georgia Maheras - Health Law Advocates - Boston

Doral Dental has been operating as the administrator for the MassHealth Dental Program for just over a year now - so how are they doing?

In January 2008, the prior authorization system was streamlined – for children, this means that the majority of services no longer require a prior authorization. Faster service with less paperwork means healthier kids. (A flyer from Health Law Advocates [PDF] explains the changes to MassHealth Dental.)

Prior authorizations for adults have also gotten easier, but there are still many times when a MassHealth member needs Doral Dental’s "Intervention Services" to help shuttle them through the prior authorization or appeals process. Working with this part of their Boston office, members (and advocates) are able to submit documents in support of medical necessity and make sure approved services are processed.

There is, however, potential for this department to get overwhelmed with the 1.3 million MassHealth members trying to access care. Have you encountered any difficulties, or great success, with the "Intervention Services" office? What are you hearing from MassHealth members?

doral

I have Commonwealth Care plan I and Doral Dental. My medical insurance is absolutely wonderful. But the dental insurance? I have always takwn good care of my teeth, usually paying out of pocket, but now I am avoiding having my teeth taken care of because both times I went to a Doral provider it was absolutely horrible. The first time the office was FILTHY and I mean that, I won't go into details. So I switched to another 35 minutes away and the dentist really hurt, botched a filling, my tooth ended up cracking, now I need a root canal but I don't know where to go. I am scared to do anything.

mass good choice

I lost my Job No insurance and thought, thank god for Mass Health-But After today I am kicking myself for going and using a Doral Dentist. I broke my tooth monday and got an appointment on Wed with an approved dentist. Man I was repulsed. the place was gross-There was a drunk guy being treated- It was ghetto, I digress. So I go in for just this tooth. He says no problem. I didnt want a cleaning but he said to do it because it was "covered" and by the way the broken was is not. So he said he was just going to file it a bit so it wasnt sharp and I could get it pulled under the insurance but not capped. THEN HE PULLED THE REST OF THE FILLING OUT so it would not get infected and sent me away. 800 out of pocket for a cap. The insurance only caps front teeth so i am screwed. Big hole in my tooth. I would rather not have insurance then have half assed ghetto coverage.

Denture problem

Just curious to find out if there is anything that I can do to get the procedure done to put what I was told picks into your jaws to hold your dentures in place? I am on Disablitly and basically told low income. I have a horrible problem with my dentures because I have very little gum to hold them into place. Nothing but this procedure can be done to help me my dentist told me. I have to use the denture paste glue to hold them in and if I take one bite of food that has and hard or very chewy consistency to it my dentures fall out. I don't enjoy eating out with friends at all and am almost always without my dentures around my own home because of this. I can't eat much of anything unless it is very soft and pliable. It is making me extremely depressed over having to continuously take my teeth out. I can hardly eat any fresh foods like fruit or veggies because of it and I am a diabetic so am generally eating a lot of sweet foods because it is usually those type of foods that don't have any kind of texture to hurt my gums since I don't wear my teeth becuase they come out so easily and often. I am 61 years old and not wanting them for my looks but for my health. Is there any way I can get any kind of help in obtaining these very expensive implants to help me??
Thank-you very much for your help and advice. Just asking as I was always told it NEVER hurts to ASK..
Again, Thank-you!!
Your Friend in need,
Robbe
May 31,2009 12:06 AM.

re: Denture problem

Dear Robbe,
If MassHealth is refusing to cover this service, you might try calling the Health Care For All Helpline at 1-800-272-4232 to see if it is possible to file an appeal. Another resource is legal services; they also help with MassHealth appeals (a directory of their offices is available at www.masslegalservices.org/perl/services.cgi).

It seems obvious, from reading your comment, that new dentures with implants would enormously improve your health. However, I am not sure what MassHealth covers. If it isn't possible to get the dentures you need by filing a MassHealth appeal, you may also want to try calling the Massachusetts Dental Society at 1-800-342-8747 to see if they have any leads. I'll also email you this info.
I hope this helps,
Laura

responsibility

A good dental benefit is something that people and everyone could make use without any hassles or problems. People responsible for providing this should be more aware and address the issues revolving around their patients and members. Their memebers should also know to what extent their coverage is.

As I see it, the major

As I see it, the major problem is the fact that we do not have a single-payer system. I think we are moving towards this with recent legislation in Massachusetts, so I am hopeful.

Hi my name is Natasha and I

Hi my name is Natasha and I have limited Mass health, but how ever I have three root canals that need to be done.Do you accept mass health. Thank you

Re: Hi my name is Natasha and I

Hello Natasha,
It sounds like you need to talk to someone who is used to working with the MassHealth dental system and could give you advice for your individual situation. I recommend calling the Health Care For All helpline at 1-800-272-4232.

Or, if you email me at landerson @ compartners.org, I may be able to find someone in your local area who could help you get it figured out.
Hope this helps,
Laura

Doral Dental... what's the point?

The dental benefit through MassHealth/Doral is worthless in my opinion. What's the purpose of having a benefit if I can't use it?

The problem:

Most dentists don't accept it MassHealth.

Most of the dentists who do accept MassHealth will only treat members who are under 21.

Most of the dentists who see adult MassHealth members aren't accepting new patients.

Most of the dentists who are accepting new adult MassHealth members are scheduling 6 months to a year out and won't provide urgent care unless you are an established patient.

I called all the dentists in my town, in neighboring towns, and in all the towns within a 30 mile radius. When I was unable to find a dentist on my own, I called Doral. I spoke with a very nice, sympathetic woman who truly wanted to help me---unfortunately, the only she could do was call dentists on the MassHealth/Doral list... the same MassHealth/Doral list that I had. She called the same dentists I called and not surprisingly, got the same answers I did.

She did eventually find me a dentist... I only had to wait 3 months. It took me 45 minutes to get there, and once there, I discovered that his office was on the 2nd floor of a building with no elevator... a big problem for someone who uses a wheelchair. The MassHealth/Doral list said that his practice was "Handicap Accessible." Stupid me---I thought that meant that disabled people would be able to access the building. Three months wasted.

The dentists I've seen through MassHealth/Doral--three of them now--were horrible. One made inappropriate comments about my gender and presumed sexuality, and then followed it up by telling me I was lazy and needed to get a job. Another had a really dirty office in a dilapidated building... and didn't wash his hands between patients. My favorite, however, was the dentist who refused to use anesthetic to numb my mouth when he drilled/filled my tooth. I told him to stop and when he didn't, tried to pull my head away... he and his assistant responded by pushing my head against the chair so I couldn't move and continued to drill.

I have a number of cavities left and visible decay. My teeth are rotting and there's nothing I can do about it. My teeth hurt most of the time and I'm embarrassed to smile. I'm afraid that by the time I get to a dentist, my teeth will be so bad they're beyond fillings--I'll need root canals and other extensive dental work. MassHealth only covers fillings and extractions. If things don't change--and fast--I'm going to end up with dentures at age 30.

Wonderful.

get a job you lazy

get a job you lazy loser...........

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