Wednesday, July 27, 2016

Dental Insurance Rip-Offs… Consumers Beware!

 
imageDr. Michael W. Davis maintains a general dental practice in Santa Fe, NM. He serves as chairperson for Santa Fe District Dental Society Peer-Review. Dr. Davis also provides a fair amount of dental expert legal work for attorneys. He may be contacted via email: MWDavisDDS@comcast.net


 
  Dental Insurance Rip-Offs… Consumers Beware!

One of the biggest scams facing dental consumers are products sold to them, which are misrepresented or falsely presented as dental insurance. The reality is usually quite different. Other times the product sold to the public is truly dental insurance, but it has virtually no value or entirely no value to the consumer. The bait presented to the potential dental patient is low- cost monthly payments for insurance. Unfortunately in too many cases, the dental consumer is hustled out of their money with little or nothing to show in cost savings or benefits.

Bogus Dental Insurance Plans
 
There are swindlers who sell consumers all sorts of insurance plans for low-cost monthly payments. Sadly, the plan administrators failed to secure the services of any healthcare providers, assuming these bogus insurance plans even have an administrator. All legitimate dental insurance programs must be registered within the states they do business within. They must comply with each state’s rules and regulations for dental insurance. A check with your state insurance commission will provide you with a listing of all duly and lawfully registered insurance providers. If the dental insurance company providing the plan isn’t listed, that’s a red flag warning. Stay far clear of that company.

Discount Programs
 
Discount programs for dental services are too often presented in a deceptive format, which gives the impression of dental insurance. For that reason, numbers of states have outlawed these discount plans. In no case are these dental discount plans regulated by the state insurance commission. However, numbers of state attorney generals have attempted to close down these dental discount card programs, in service of the public interest.

Some discount dental programs are sold by independent companies, with little or no background history available. They may or may not even have enrolled dentists, who participate and honor their discount cards. Too often, the few dental clinics which do accept these discount programs artificially inflate their fees, to offset any consumer savings. Other dental clinics find these discount plans work to get customers in the door, for more profitable bait-and-switch scams or hard-sell upselling of additional services. Unfortunately, consumers attracted to purchase these discount cards are frequently financially disadvantaged, and not particularly sophisticated in dishonest business dealings. They are primed for the plucking.
Large corporate dental clinics also sell dental consumers a variety of discount dental plans, which are administered under their company. Again, numbers of states have outlawed these plans, because they too closely resemble lawful insurance programs, which they are definitely not. Some corporate dental outfits manipulate and misrepresent their fees in a variety of ways, such that patients purchasing a discount plan actually may have no cost savings, or actually pay more, than patients utilizing standard dental insurance.

Sales of dental discount plans have become so lucrative, that bonafide dental insurance companies have entered into this racket. It’s highly profitable for them, as they don’t need to register these plans as insurance vehicles with any state regulatory commission, and they aren’t as subject to state or federal auditing. Moreover, these discount plans cost the insurance company no outlay of expenditures for patient dental benefits. Since there is no remuneration paid to dental providers by the insurance company (only a promise by dental clinics to discount fees), the insurance company has little incentive to monitor or audit billings from dental providers. Unfortunately, too often the same bait-and-switch and hard-sell upselling we see with corporate dental clinics, also happens with dental clinics accepting dental discount cards sold by an insurance company. Once again, consumers get screwed.

Dishonest Dental Insurance
Dishonest dental insurance has become a highly popular swindle, especially since the inception of the Affordable Care Act (ACA) and the various state insurance exchanges. Yes, these are genuine dental insurance programs, many of which are specifically designed to cheat consumers. With all the new changes in the insurance industry, many state regulators are ill-equipped to provide appropriate oversight. In this deceitful quagmire of the insurance industry, consumers are at risk. Let’s examine some of the more popular methods of gaming dental patients.

Numbers of health insurance companies today sell dental insurance at an additional upgrade fee. What often isn’t disclosed to the plan purchaser is that the dental coverage is fully embedded in the medical insurance plan. The consumer is sold on dental insurance, which covers preventive dental services, along with many restorative services. What isn’t disclosed is that the consumer often must reach the medical deductible limit of $5-6,000, before they become eligible for dental benefits.

Saturday, July 23, 2016

Association of Dental Support Organizations Tax Return Comparison 2007 thru 2013

Association of Dental Support Organizations Tax Return Comparison 2007 thru 2013

Nashville Based Marquee Dental Partners: Just Another DSO

Am I the only one to notice that every Dental Support Organization (DSO) markets themselves as the grand poohbah of the DSO industry? Marquee Dental Partners, who launched in October 2015 with a $35 Million investment from Chicago Pacific Founders, says they are the premiere of DSO’s. 

Let’s look at this up-and-coming DSO.

According to their website, they now own 19 practices in the Southeast. The headline reads, “Marquee Dental Partners Acquires Bryant Dental, Expands to 19 Practices in Southeast “.

By “acquire” I assume the 19 practices were not given to them, right? Must have bought them, right? So now they own them, right?

July 2016: Bryant Dental – 3 Locations - Alabama - Founder - W. Forrest Bryant, DMD
May 2016: Save-On Dental – 5 Locations - Alabama - Co-founder Dr. John Denton
May 2016: Signature Smile – 2 Locations - Alabama - Dr. L. Don Wilson and Dr. Kristen Bentley
January 2016: Winfree and Denton Cosmetic and General Dentistry – 1 Location - Hermitage, TN - Dr. Terry  Winfree, DDS, and Dr. Greg Denton, DDS
December 2015: Bohle Family Dentistry – 1 Location - Paducah, KY- Dr. Chip Bohle, DMD
October 2015: Embassy Dental – 7 Location - Nashville, TN - Founder Dr. Warren Melamed

With each “acquisition” Marquee Dental Partners releases a statement that claims:

“...to have entered into an affiliation agreement”
“…provide dentists with both support and clinical autonomy they need”
“…seamless transition”
“…acquired the business end of [clinic]
(fill in the blank founder/dentist) will continue to either be actively involved or continue to provide high quality care for patients.

Checking the Tennessee Secretary of State Website I found the following:

Marquee Dental Partners, LLC , a Delaware company, entity filing date 2/12/2015

Name: CPF Dental, LLC (Chicago Pacific Founders Dental, LLC)
Formed in: Delaware
Original Address: 23 Northumberland, Nashville, TN 37215 (home of James Usdan and Lisa Butlak)
Principal Office Changed on April 2016 Annual Report to: 2025 21st Ave, Ste 204, Nashville, TN 37212
Number of members: 1 (likely James Usdan)
Assumed names: Embassy Dental and Marquee Dental Partners
Consent Given to Name Change from” No value To: TN Dental Professionals, PC

TN Dental Professionals, PC has assumed names listed as:

Winfree & Denton
Winfree and Denton Cosmetic and General Dentistry
Embassy Dental
Marquee Dental Partners

There is also a TN Dental Professionals, II PC started February 1, 2016. No assumed names, yet. Registered Agent is Donald R. Moody, 511 Union St. Ste 2700, Nashville, TN 37219-1791.

From Marquee Dental Partner Website:

Marquee Dental Partners Launches with $35 Million in Funding to Support Dental Practices

October 13, 2015

Nashville, TN – October 13, 2015 – – For many dental practices in today’s market, the pressures of performing administrative and billing functions prevent them from focusing their attention where it’s most needed: their patients. Launched with a $35 million capital commitment from Chicago Pacific Founders, Marquee Dental Partners provides dentists with both the support and the clinical autonomy they need to succeed.

Friday, July 22, 2016

Daisy Lynn Torres’ Needless Death Raises Questions

In March, Daisy Lynn Torres’ parents took her to Austin Children’s Dentistry in Austin, Texas to have stainless steel crowns placed on two teeth. After the dentist got his hands on Daisy, he suddenly found she needed a total of 6 crowns. This is the classic bait and switch dentistry I hear so often which sadly has become the norm.

During the procedure something went terribly wrong and baby Daisy went into cardiac arrest. 911 was dispatched and Daisy was taken to the hospital where she was later pronounced dead. According to the heart wrenching story in People Magazine, Daisy’s mother, says her daughter was “dead before she even left the dentist office”.

Fast forward to July 15, 2016, NBC affiliate KXAN in Austin published a story suggesting Daisy Lynn, didn’t need the procedure. Not exactly a shocker. 

“One can only speculate as to why any treatment was performed considering no indication of dental disease or pathology was seen in the dental radiographs (x-rays) in the dental visit dated 03/29/2016,” writes Robert Williams, a forensic odontologist. While the initial x-rays prior to work being done showed no disease, the report does note that x-rays taken after the child’s death indicated four teeth appear to have dental work performed on them. According to the report, the child’s teeth had been prepared to have stainless steel crowns placed on them.

“It is possible that the partially erupted teeth may have had a congenital enamel defects but not necessarily requiring treatment with a child of this age,” the report notes. “No evidence that the child was in any type of pain was ever notated in the dental record and no pulp vitality test was ever performed.”

According to KXAN, the initial report from the Travis County Medical Examiner mentioned a difference of opinion between Dr. Michael Melanson and the forensic odontologist, and it wasn’t until the station requested the entire report was it revealed just exactly how much those opinions differed.

The report also states Austin Children’s Dentistry has suspended Dr. Michael Melanson. However, I find no evidence of the any disciplinary actions taken by the TSBDE. In fact, as of July 22, 2016 Dr. Michael P. Melanson’s dental license shows no Disciplinary Actions whatsoever.

160722 Michael Melanson dental lic-clean

Of course Austin’s Children’s Dentistry says of course no evidence was found that the child needed the procedures, it had been removed; the standard boilerplate statement. 

“The report reveals no surprises to us. By the time the forensic odontologist evaluated Daisy, all evidence of dental disease had already been removed by the dentist, as expected. A treating dentist always has the advantage of pre-treatment visual exams, clinical findings, and x-rays on the patient; as well as knowing the patient’s dental history, unlike a forensic odontologist. The treating dentist in Daisy’s case will present all of the evidence that justified Daisy’s treatment if called on to do so.”

Well, I’m certainly waiting for Austin Children’s Dentistry and Dr. Michael Melanson to be “called on to do so”.

Just two months prior to Daisy Lynn’s death, 4 year old Navaeh Hall had gone to Diamond Dentistry in Houston where Dr. Bethaniel Jefferson's treatment left Navaeh severely brain damaged. The Texas State Board of Dental Examiners placed Dr. Bethaniel Jefferson’s license on temporary suspension. “In essence what happened is this child was chemically and physically suffocated,” stated Jim Moriarty, the attorney reprsenting Navaeh Hall and her family. Was this also what happenedd to Daisy Lynn Torres?

Here are my questions:

1. Was little Daisy and these parents victims of Bait and Switch Dentistry at Austin Children’s Dentistry? I believe they were.

2. Who owns Austin Children’s Dentistry? There is substantial evidence to suggest it is owned and operated by Tal Shohomy, a Wall Street trader, who also owns/operates White Angel Veterinarian Clinic. where his wife is a veterinarian.

Tal Shohamy Bio from White Angel Verterinarian Clinic:

Tal Shohamy Bio

3. Was Dr. Melanson being pressured to overtreat in order to bilk Medicaid/Insurance? We know it is common these days to “milk the cow dry” as it was so eloquently stated by Small Smiles dentists.

4. Where was this anesthesiologist who was supposedly monitoring Daisy? Chatter in the dental community suggests he wasn’t even in the room with Daisy.

5. Is anyone suing this dentist, owners and clinic? If not, why the hell not!

6. Has a complaint been filed with the Texas State Board of Dental Examiners? I would hope so!