I n s ura n ce Con nect ion
In July, members of PDA’s Dental Benefits Advisory Group (DBAG)
participated in a conference call to strategize and develop
action plans to contend with emerging dental benefits issues.
Staff is in the process of scheduling meetings with
representatives from all of the major dental carriers to discuss
problems members are experiencing due to their policies and
procedures. Advisory group members plan to attend, to work
on your behalf to rectify some of the administrative hassles you
experience when working with these carriers.
Disallowing Services
DBAG is investigating some carriers’ current practice of
disallowing services, the most prevalent of which appears to be
scaling and root planning, crown, impacted third molars and
failure to pay for IV sedation for extraction of third molars.
DBAG members believe this to be an ethical violation that may
also have legal implications, if it is considered to be a breach of
contract of the insurance provider agreement and/or restriction
of trade. DBAG members believe that it is vital for PDA to take
a stand against this practice, and agreed to the following course
of action:
would regulate dentists and other health care professionals
who participate in the delivery of services without actually being
present to exam and diagnose patients before services are
rendered. These providers remotely exam and diagnose patients,
and authorize treatment, from other locations through
technology. The legislation also requires insurers to cover services
rendered remotely.
DBAG will focus on the insurance coverage aspect of
teledentistry to ensure that any codes and coverage adopted
by carriers in Pennsylvania conform with the ADA’s newly-
developed teledentistry codes.
If you have an item you would like to bring to the advisory
group’s attention, please contact Vince Pinizzotto,
PDA’s independent insurance consultant, at (800) 223-0016,
or vjp@padental.org.
• Contacting the insurance carriers to request an explanation of
their criteria for disallowment of payment for services rendered.
• Publishing information for members explaining the difference
between non-covered services and disallowed services.
• Coordinating with PDA’s government relations committee
(GRC) and the Board of Trustees to determine the best course
of action that would prohibit carriers from instituting the
disallowment practice. PDA will consult with the ADA , which
may provide states with model legislation to use if they
pursue a remedy through legislation.
Teledentistry
The advisory group is working with the GRC to monitor and
respond to all legislative and regulatory proposals pertaining to
the remote delivery of health services (including dental services),
commonly referred to as “tele