Medicaid Switch Still Causes Glitches In Pa.

But dentists and physicians have faced more obstacles. They must be credentialed and sign contracts with the managed-care companies to be reimbursed for their services.

"We have been trying to get credentialed since Aug. 29, and they are still telling me two more weeks," said Shapter, who said he has been in contact with all four plans, though he wouldn't sign with all four.

"I already was credentialed by Medicaid, so it should be a smooth process."

The DPW agreed to a 60-day grace period in which doctors and dentists who accept Medicaid would continue to be reimbursed, whether or not they were credentialed and under contract with one or more of the four plans.

But that grace period runs out Dec. 1. Providers who don't sign a contract with a specific plan will not be paid for treating patients under that plan.

"I don't see that as a problem with Dr. Shapter," said John Lovelace, president of UPMC For You, one of the four Medicaid managed-care plans. "Dr. Shapter is on our radar."

Shapter and Lovelace said reimbursement is a separate issue.

The Erie dentist is negotiating with UPMC For You for an increase in his payment rate.

"We are asking for adequate reimbursement," Shapter said. "Our costs have not been addressed in 12 years, though our expenses have gone through the roof."

Lovelace said UPMC For You pays a higher rate than traditional Medicaid, though lower than commercial dental insurers.

Other dentists and doctors are going through the same process with Medicaid plans.

But the lack of pediatric dentists in this area who accept Medicaid might mean families will have to travel to Pittsburgh for treatment.

Instead of arranging transportation to Pittsburgh, many of these families will just let things slide, said Linda Hackett, health and disabilities coordinator for the Warren and Forest County Head Start Program.

"When you tell families around here that they need to go to Pittsburgh, you might as well tell them they have to go to New York City," Hackett said.

The fear is that children with extreme decay develop life-threatening infections, Shapter said.

"It's rare, but I have seen examples locally," Shapter said.

The Van Ords hope that Shapter is able to continue treating their children. They recently took 71/2-month-old Alexander to his first dental visit.

"We might have to look into something, but the kids love it here," Steve Van Ord said. "It's a drive, but you do what you have to do."

DAVID BRUCE can be reached at 870-1736 or by e-mail. Follow him on Twitter at twitter.com/ETNbruce.

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