Managed Care Page

August 4, 2001
United Concordia, a subsidiary of Blue Cross of Pennsylvania, has caused substantial problems for our patients, and those of other offices, by denying claims. Articles in the newspaper have talked about the games Blue Cross has played by denying and delaying claims, to such an extent, that hospitals and Philadelphia requested that the State Insurance Commission deny them any rate hikes. An article in today's Philadelphia Inquirer addresses a law suit, brought by a local employer, contending that this nonprofit organization has, "instead of pending the surplus on better benefits and lower premius for subscribers, or coverage for Pennsylvanians who cannot afford health insurance, Blue cross transferred tens of millions to for-profit ventures under the corporate umbrella of the nonprofit insurance company." 

August 21, 2001
The American Dental Association (ADA) and two of its member dentists sued Aetna yesterday, charging the giant insurer with breach of contract, libel and unlawful interference with the dentist-patient relationship. Filed here in U.S. District Court for the Northern District of Illinois, the class-action complaint seeks relief under the Employee Retirement Income Security Act (ERISA) for breach of contract, and under supporting state laws for the trade libel and tortious interference
charges. Learn more

E-mail your comments and questions

Dentists: Upload Dr. Maroon's letter to the ADA here.

Excerpts from the book,

Health Against Wealth - HMO's and the Breakdown of Medical Trust,

by George Anders (Houghton Mifflin Publishing - NY, 12/96). Mr. Anders is a senior editor at the Wall Street Journal.

Noted economist, Robert J. Samuelson has written in The New York Times Book Review: "Offering an urgent expose¢ of the medical juggernaut that is sweeping the country and endangering our health, Health Against Wealth takes an unflinching look at the profit-hungry entrepreneurs who have poured into this new "health industry" and provides alarming examples of political manipulation by powerful HMO lobbyists."

It is our feeling, and the belief of the majority of quality-oriented dentists throughout this nation, that managed care programs, programs which necessitate that the dentist deeply discount his fees in return for truckloads of patients (delivered by the insurance companies) do not promote quality dentistry. Shortcuts are taken, necessary treatment is ignored, or procedures which pay the dentist substantial surcharges are substituted for proper care. Specialty work is performed by general practitioners. The purpose of this segment of the website is to educate the public about the shortcomings of managed care, and to encourage patients to insist that their employer not take away their right to see the dentist of their choosing.

"Ensuring patient welfare comes first: Dr. Ten Pas"

ADA President speaks on managed care to House subcommittee

In the June 10, 1996 issue of the ADA (American Dental Association) News, the President of the ADA, Dr. William S. Ten Pas was quoted on the occasion of his appearance before the House Commerce subcommittee:

"We see a very real danger of the patients' health becoming secondary to the bottom line. We have go to change the scale from cost containment, to value." 

What is significant about the above quote is that for the first time, the ADA has joined us in taking a stand to educate the public. The ADA has organized the Coalition For Health Care Choice and Accountability which represents more than 50 health and consumer organizations promoting patient/provider protection legislation: HR 2400, the Family Health Care Fairness Act.
Up until now, the rhetoric we received from the ADA was that they were restricted due to fears of Antitrust suits.

The June 24, 1996 issue of Newsweek carries the following ad from the American College of Surgeons:

At the Centre for Dentistry, we have taken a hard stand against managed care since its inception. We have worked diligently to educate our patients to the pitfalls of a system that allows the insurance carrier to dictate care.  Click here for The American Dental Association managed care patient advisory.

Everyone knows that insurance companies are in business to make (lots of) money. They have never made as much money as they are making under managed care. At who's expense? The health care provider, and the patient.

There is a backlash coming. Employees are going to resent the fact that the level of care they are entitled to is no better than that of a Medicaid recipient. Physicians are going to be sued at record rates because they are not treating patients to their best ability, but rather are governed by their bottom lines.

As you are probably aware, or have seen from the information on our Web site, dentistry has come a long way in the past 20-30 years. Managed care seeks to turn back the calendar to 1955. There will be little to gain (for the practitioner) to help patients keep their teeth. Reimbursements are the same under managed care, whether you perform just the most cursory of exams and cleanings, or perform extensive dentistry.

Dentistry did not need cost-containment by the insurance industry. Insured patients were always limited in terms of annual maximums, co-pays (often substantial for major treatment), and deductibles. The dental profession, unlike our medical colleagues, recognized that the costs involved in lowering our standards of care were far greater than dollars and cents.

What can you do?

Correspondence used by our office about HMO's:

1. A letter dentists can use to attempt to reactivate patients who left their practice because of HMO's.
2. A letter used to try to promote the formation of an IPA (independent practice association) which addresses the fears of antitrust action.
3. A letter that we send to managed care companies that attempt to convert us into "Preferred Providers. "

Recent news articles with negative information on H.M.O. 's:

Updated, Spring 2001 - New Articles

1. AMA doctors say managed-care companies are muzzling them to keep them from telling patients about the medical implications of cost-cutting policies.
2. Opthalmologist fights Keystone HMO over quality issues
3.Doctors say that the proliferation of HMO's is cutting down on the amount of medical research being done.
4. Organized Crime targets managed care as another means to amass dollars - August 22, 1996 article from the Newark Star Ledger
5.Excerpt from "Managed Care: A Wake-up Call"
6.Excerpt from "Impact of Managed Care on Practice Value" - (Pride Institute)
7.Anti HMO Poem from JAMA, 10/96
8. A typical letter written by a quality oriented dentist who tried to make mangled care work in his office.
9. Community National Bank of New Jersey Drops Dental HMO - text of their internal memeorandum.         return to red button area
10. Dec 9, 1996 Newsweek Article : To Sue or Not to Sue -- Why you can't sue the managed-care company for alpractice!
11. Smoke and Mirrors An extremely well-written article explaining the money grab going on within the healthcare industry.
12.The letter Dr. Michael Maroon, who attended "The Summit to Save Fee for Service Dentistry" at Keystone, Co. in August 1996 wrote, and was published in "The Profitable Dentist Newsletter. "
An extremely well-written letter explaining to the ADA and others within the dental hierarchy, that the status quo no longer applies. We need a governing body that is responsive to the needs of general dentists vis a vis managed care, treatment of patients with communicable diseases, etc. The letter can be downloaded to your word processor and reprinted and sent, without difficulty to the ADA.
13. NJ Senate passes far reaching bill to control HMO's - Consumer advocates thrilled - Finally, something good about life in the Garden State.
14. 7 year girl with toothache denied dental care by her HMO
15. Cataract Surgeries denied senior citizens in HMO's