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Story on Dental Plan Gives Cause to Worry About Managed Health Care

July 04, 1993

The scandal revealed in the Times article ("O.C.-Based Dental Plan Cheats the Poor, State Says," June 26) is alarming not only for what the plan did to its dental victims but for what that foretells of what may happen to all of us when so-called managed care medical plans become the only health source for the vast majority of our citizens.

In a highly critical audit, DentiCare, a dental care subcontractor to the Cigna Health Plan, a huge insurance firm almost certainly destined to be one of the primary payers for medical managed care in Orange County, stands accused of retaining 46% of every health care dollar for administration. This compares with Medicare's approximate 5% to 7% overhead and is three times the 15% considered acceptable for commercial management costs. Only 43 cents of every dental care dollar "trickled down" to the dentists actually treating patients. If Cigna knew this, why did it allow it? If it didn't know it, why not?

Just as alarming, from a doctor's point of view, are claims by some dentists that requests for service were unconscionably delayed for weeks and that many requests for treatment were seemingly randomly denied. Arguably some dental patients may not suffer from delay. However, does this example prophesy how Cigna or some other managed care intermediary will delay and capriciously refuse requests for angiograms, open heart surgery or hip replacements?

Does the high percent of dentist turnover provoked by DentiCare's apparent indifference to patient need presage a similarly high percent of medical doctor churning, making it necessary for medical patients with serious and-or complex problems to see a new physician who does not know them, at every other visit?

Managed Care is promoted as more efficient than fee-for-service care. But not if the insurer keeps a whopping 45% of the health care dollar; not if patient care suffers from massive physician and patient turnover.

We all agree that medical costs must be reigned in. Let's be sure we do it cautiously without the taint of corruption and the potential for harm to the innocent. Maybe fee-for-service medicine is not the overpriced ogre the cost-containment gurus describe.


Garden Grove

Dr. Silk is on the Board of Directors of the Orange County Medical Assn..

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