Free Notice (Other) - District Court of Connecticut - Connecticut

Case 3:OO—cv-O1050—AVC Document 176 Filed 07/25/2008 Page 1 of 3
"NOTICE OF INTENT TO COMMENT"
Case: Carr v. Wilson- Coker, Civ. Action No. 3:00CV 1050
Melissa Riley, 452B Stafford Rd, Mansfield CT 06250
HZ 860-450-1327 WZ 860-646-0773
SEE ATTACHED LETTER FOR COMMENT

Case 3:00-cv-01050-AVC Document 176 Filed 07/25/2008 Page 2 of 3
I am writing to object to the settlement ofthe Carr VS Wilson- Coker lawsuit against the state. I feel the
lawsuit settlement will not fix the problems with the state administered Husky A&B insurance program.
The new fees are not acceptable for adults as they are a drop from the original fee for children. I
personally work in a dental office that participates in the Husky plan and currently we have had so many
problems with getting payment, for services that are supposed to be covered.
The department of social services is well aware that Anthem the major insurer of the Husky plan has
given out "special" contracts to in network dentists. The new fee schedule slightly exceeds the fees that
the dentists are receiving for children under the age of 2l. However, this change in fee schedule reduces
the fees for patients over the age of 2l who are already in active treatment to 50% of the networked
provider’s fee. In network specialists have already stated that if the adult fees drop they will no longer
participate. New participating dentists will only take patients up to the age of 21, although they have been
instructed that they cannot limit their patient base by age. The fees have not been increased in 15 years
and the patients who were children who did not receive care will not receive care as adults. 52% of the
children’s fee schedule is beneath the cost of doing business for dentists. No dentist will perform
dentistry, engage in potential liability and pay to perform the treatment. The fee for a crown has
increased $3.00 in I5 years and won’t increase for another 15. We have already received letters from
doctors at Columbia dental who are not pediatric dentists stating that they will accept patients on the
HUSKY plan up to the age of 2l but no older. These letters have been forwarded to DSS but no one
cares. This is a despicable situation for the dentists and the patients. Without adult care how can the
parents reinforce the necessity of good oral hygiene to their children‘?l The office that I work in is a
private practice that will be forced out of business by this change in fee schedule. Furthermore, the elder
population will be discriminated against. Ask Senator Edith Prague how she feels about that!
I have personally written to President George W. Bush, Vice President Dick Cheney- who in tum wrote to
me advising me to contact the Department of Health and Human Services, back in 2007 and have heard
nothing in response. I have personally written e-mails to contact state senators and political party
representatives, all with no response or help to correct the issue. So now it is 07/08 and the office I work
at had claims pending and DSS workers, specifically Donna Bialaski was supposed to have reviewed our
claims and made payment, however she did not review the correct items and out of $70,000 worth of
submitted work, only $3,000 has been paid. If the federal government is giving corporate insurance
companies millions of dollars of money, so husky patients can receive care, if the office doing the work is
not getting paid correctly if at all, then I would like to know where all the money is going. People are in
desperate need of dental care and the stereotype that Husky patients are all low class, dmggies or of non-
American decent is a disgrace for basis to deny payment. The Husky population that I myself am
included in is very hard—working and typically can only afford to have one income as daycare expenses
are very high( so much so that you lose in the end by having to work just to pay for daycare) , and the
care is not as satisfactory as being home with mom or dad. Wards of the state (children in foster care/
halfway houses) have even been denied treatment or at least payment for behavioral management, how is
it that the state won’t even pay for their own‘?!
As far as my own history I am fortunate enough to not need major work, however my fiancé was in need
a root canal and he was forced to live in pain for months as the insurance HealthNet at the time would not
authorize him to have the root canal. Also when they finally allowed him to go, he could not find a
dentist participating with the plan, therefore we needed to change our plan to the Blue Care Family Plan

Case 3:00-cv-01050-AVC Document 176 Filed 07/25/2008 Page 3 of 3
which was the only plan being accepted by dentists, and even that took a while to find someone to want to
do the root canal. This practice of turning away patients with dental needs is unacceptable for anyone to
encounter. Afier my fiancé had finally had his root canal, we were informed months later that the office
was not paid for services, even though it was a covered benefit of the plan, he had to send in an appeals
notice to DSS after having had argued with the insurance company as to why we were not informed of
non-payment of services only then would they send the letter of appeal to him.
I am very disappointed by the actions of social services and the insurance company HEALTHPLEX for
making determinations of medical necessity, even though they are not qualified doctors to do so. I am
very disappointed that DSS and the state government feel that the insurance company is not liable to be
held to any ethical standards in my eyes.
Respectfully yours,
Melissa Riley
452B Stafford RD
Mansfield CT 06250
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