Florida's inaccurate health plan directories frustrate parents and dentists
Maggie Clark’s reporting on Florida’s Medicaid program for children was undertaken as a project for the Dennis A. Hunt Fund for Health Journalism, a program of the University of Southern California Center for Health Journalism.
Other stories in the series include:
Medicaid in Florida: 2 million kids. $24 billion battle.
Fighting for care in Florida's Medicaid system
An impossible choice: Doctors torn between patients and Florida's Medicaid system
2 Million Kids' series spurs support and quest for more data
Medicaid settlement: Florida will work harder to ensure health care for children
Medicaid health plans regularly send out paper directories to their members. The plans also maintain directories online, which a Herald-Tribune survey showed are often inaccurate.
In Florida, nearly every Medicaid-enrolled child accesses their dental care through a private health plan. The Medicaid health plans are paid with taxpayer dollars, and in return, the plans are required to follow specific rules as outlined in their contracts with the Florida Agency for Healthcare Administration.
Mainly, plans are responsible for creating networks of dentists willing to treat Medicaid patients. Those directories of dentists are publicly available online and printed copies are regularly mailed to members. The directories are meant to guide parents when they need to find a dentist for their child.
Plans must ensure they have at least one dentist for every 1,500 enrollees and that their patients can receive a routine dental check-up within one month of making an appointment. The dentist must also be no further than 35 miles for any member’s home in an urban county, or 60 miles from a member’s home in a rural county.
In Sarasota County, the more than 20,000 Medicaid-enrolled children have four health plans to choose from, and each is responsible for creating a network of dentists. The four health plans are Molina, Prestige, Sunshine and Staywell (Liberty Dental).
Herald-Tribune journalists designed a survey to check the accuracy of the online provider directories of each of the four health plans. We used the Herald-Tribune address, 1741 Main Street, Sarasota, Fla. 34236 as our home location, and searched for dentists within 35 miles of our location.
Overall, the four health plans identified 103 dentists within 35 miles of the Herald-Tribune building.
An important note: dentists’ offices, including the ones contacted for this survey, are not responsible for how their information appears in health plan provider directories.
Many dentists are willing to accept patients and provide care as they can, but their information is not correctly listed in the health-plan-created provider directories.
Journalists called the offices over an 8-week period between March and May of 2016 to verify all the information listed on the health plan provider directory. For more on the methodology, please see the “Methodology Notes” section.
For the notes in the spreadsheet, please see the “Spreadsheet Notes” section.
(Spreadsheet available on website)
HOW TO USE THE SPREADSHEET
To use the spreadsheet and find out if a dentist was accurately listed in a health plan provider directory, follow the steps below. Clicking the columns out of order will not produce accurate results:
- Scroll from left to right to find the column labeled “Health plan acceptance matches website”. In the column labeled “Health plan acceptance matches website”, click on the column header until the word “Yes” is displayed in the top row. Reading the chart left to right, you’ll find just 26 of the 103 dentists listed actually accepted the health plan as indicated on the plan website. Scroll to the right to find the next column.
- In the column labeled “Does the dentist workplace information match,” click on the column header until the word “Yes, but he is a periodontist (7)” is displayed in the top row. Scroll to the right to find the next column.
- In the column labeled “Phone number correct based on reporting”, click on the column header until the word “Yes (1)” is displayed in the top row. Scroll to the right to find the next column.
- In the column labeled “Address correct based on reporting”, click on the column header until the word “Yes” is displayed in the top row. Scroll to the right to find the next column.
- In the column labeled “Miles match health plan website information”, notice that none of the miles listed on the health plan websites match the calculations from Google Maps. While this is not a disqualifying factor for the health plans, it is an inconvenience to members. Scroll to the right to find the next column.
- In the column labeled “Age of kids matches ages listed on website”, click on the column header until the word “Yes” is displayed in the top row. Since some health plans did not list the age range of kids treated for each dentist, a “not listed (9)” answer is not a disqualifying factor for dentists listed in that health plan. Scroll to the right to find the next column.
- In the column labeled “Acceptance matches website,” click on the column header until the word “Yes” is displayed in the top row. Scroll to the right to find the next column.
- In the column labeled “Appointment available within one month based on reporting”, click on the column header until the word “Yes” is displayed in the top row. Scroll to the right to find the next column.
- In the column labeled “Do hours match”, click on the column header until the word “Yes” is displayed in the top row. Reading the chart from left to right, you’ll find two dentists who accepted the health plan as indicated on the plan website, were listed as working in the right location, had the correct address and phone number, treated the age range of children listed on the plan website, accepted new patients, had an appointment available for a new Medicaid patient within one month and operate during the same hours as listed on the health plan website.
Following this guide, you’ll find just two dentists out of the 103 listed had fully accurate information listed in the health plan provider directory.
The health plans, not the dentists, are responsible for making sure that the information in the directories is correct.
The Florida Agency for Healthcare Administration views compliance reports on the health plan provider directories each week provided by an automated system operated by an outside contractor. They also conduct “secret shopper” surveys, agency officials said.
Based on the Herald-Tribune’s survey, no health plan had enough dentists correctly listed to meet the state’s network adequacy requirements of one dentist for every 1,500 children enrolled.
SPREADSHEET NOTES:
Notes:
(2) Only available on Fridays.
(3) Accepts Molina for kids up to age 19.
(4) Office does not accept Medicaid health plans.
(5) Dentist is a pediatric dentist, but does not practice at this location based on reporting.
(6) Dentist listed by health plan is not a pediatric dentist based on reporting.
(7) Liberty site only had option to search distances from zip code. There was no option to search distances from a numbered address.
(8) Age range of kids treated not listed on health plan website.
(9) Hours of dentist not listed on health plan website.
(10) Age of kids accepted varies by procedure based on reporting.
(11) Dentist is a pediatric dentist, but does not work for Tinsworth Orthodontics.
(12) Health plan contract requires access to dentist within 35 mile range of home in urban county.
(13) Health plan contract requires access to dental appointment within one month for Medicaid members.
METHODOLOGY NOTES:
This telephone survey captures a moment in time, and we are aware that offices may change their policies about accepting new patients and participating in health plans’ provider networks. We recorded the dates for each survey response.
First, Herald-Tribune reporters built a spreadsheet with information from the provider lists for each of the four Medicaid managed care companies serving Sarasota County- Molina, Prestige, Sunshine and Staywell (Liberty Dental).
- Name of office
- Last name of dentist
- First name of dentist
- Name of insurance company
- Phone number
- Address
- Age of kids treated (if available- not all health plans listed ages on their site)
- Accepting new patients? (only when health plans indicated “accepting new patients” on their site
- Office hours
- Distance from Herald-Tribune address (1741 Main St. Sarasota, Fl. 34236)- not all health plan websites had an option to search practices within a mileage range
Then, we verified the information on the website through a telephone call to the dentist’s offices. These were the questions we answered:
- Does the dentist listed on the provider list actually work in the office listed?
- Verification of physical address
- Verification of phone number*
- Verification of distance from Herald-Tribune address (1741 Main St. Sarasota, Fl. 34236) via Google Maps; do they match the distance listed by the plan’s website?**
- Verification of age of kids treated; do the ages served they match the plan’s website?
- Does the office participate in the health plan’s network?
- Is the office accepting new patients?***
- Is a new patient appointment available within a month?****
- Verification of the dentist’s hours of availability with information on the plan’s website
*When the phone number went to another office or the wrong department to make an appointment, we marked the listing as invalid. We called each practice twice and left a voicemail if available. Some calls went unreturned, and those were marked n/a (not available because of no answer).
**Legal maximum distance based on Medicaid provider regulations is 35 miles from patient in an urban county. Providers listed on the plan websites that were outside the 35 mile range according to Google Maps were not included in this analysis.
***Only applicable to health plans that list providers as accepting new patients on their websites.
****One month is the required time frame for a new appointment based on health plan contract requirements with the Florida Agency for Healthcare Administration.
[This story was originally published by the Herlad-Tribune.]