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Insurance company policies
L E T T E R S
T O
T H E
E D I T O R
J A D A devotes th is section to co m m en t by readers o n topics of c u rre n t interest to dentistry. T h e e ditor reserves th e rig h t to e d it a ll c o m m u n ic atio n s to fit a vailable space a n d req u ires th a t all letters be typed, d ouble-spaced, a n d signed. N o m ore th a n ten references sh o u ld be given w ith each letter. P rin ted c o m m u n icatio n s do n o t necessarily reflect the o p in io n o r official policy o f the A ssociation. Y our p a rtic ip a tio n in th is section is invited.
P a y m en t for care □ In regard to the article by Drs. T ryfon B eazoglou, A lbert G uay , a n d D ennis Heffley (April), it should be pointed out that there is an o th er model of the fee-forservice system still used by m any of us today:
It is still ju st as acceptable to expect patients to pay for their dental care directly to the treating dentist as it is for grocers to expect direct paym ent at the end of our weekly sh o p p in g trips. T h e relatio n sh ip o u r patients have w ith their em ployers and any of n u m e ro u s th ird -p a rty insurers sh o u ld have n o th in g to do w ith the relatio n sh ip they have w ith their freely chosen dentist. T h ere are a nu m b er of p u re direct reim bursem ent plans aro u n d the country th at co n tinue to recognize the distinction between the doctor-patient relatio n sh ip an d the p a tie n t-th ird - p a r ty - e m p lo y e r relationship. C H A R L E S G . LEW IS. DDS M ULESHOE. TX
In su ran ce c o m p a n y p o lic ie s □ I w rite to you as a p h y s ic ia n , as a p atien t w ith his share of dental problem s, and as a p articip a n t in the dental plan of . . . insurance com pany to solicit your 818 ■ JADA, Vol. 116, June 1988
h e lp an d advice re g a rd in g a m a tte r of concern. I refer to a com p an y ’s req u ire m ent that all claim s for paym ent of dental expenses be accom panied by radiologic evidence that the w ork has indeed been com pleted. T h is req u irem en t forces the dentist to take costly, unnecessary, an d potentially hazardous radiographs. I su b m it th a t a lth o u g h the risk may be m in im a l even if c u m u la tiv e , th e ‘'m ax im u m safe dose” of ionizing ra d i ation is a statistical and n ot an absolute concept and th at, therefore, there is no excuse for ex p o su res o th e r th a n th o se dictated by professional judgm ent. T h u s, th e o n ly m o tiv a tio n s a p p e a r to be a s h o r tc u t to p a p e rw o rk a n d a d is tru s t of th e d e n tis t, th e p a tie n t, a n d th e ir records and statements. W hat is the p osition of the Am erican D ental A ssociation on the use an d abuse of ra d io g ra p h s ? W h a t ca n we d o to convince the insurance com pany to stop this practice? P IE R O P. FOA, MD. ScD W AYNE S T A T E U N IV ER SITY
□ C om m ent. T h e A m erican D ental Asso ciatio n ’s policy on the use of radiographs c o n ta in s 16 g u id e lin e s for th ird -p a rty payers and dentists. T h e p ertin en t g u id e lines include: 2. T h e use of rad io g rap h s sh o u ld be only for d eterm in in g the extent of lia b ility of th e p ro g ra m s a n d in n o case s h o u ld in f r in g e o n th e professional ju d g m en t of the dentist o r o n th e d e n tis t- p a tie n t r e la tionship. 12. P a tie n ts s h o u ld be e x p o se d to radiation only w hen such exposure is clinically necessary as determ ined by th e a t te n d in g d e n tis t. R a d io g r a p h s s h o u ld n ev er be ta k e n to satisfy the a d m in istra tiv e re q u ire m ent of a third party. F or ex ten siv e d e n ta l tre a tm e n t, an d w hen in su ran ce co m p an ies an d service
co rp o ratio n s have q u alified dentists on sta ff, p r e tr e a tm e n t r a d io g r a p h s are regarded as a second o p in io n —a practice used frequently in m edicine. However, p o sttreatm en t rad io g rap h s co n stitu te a “ g u ilty u n til proved in n o c e n t” sta te m e n t o n th e p a r t of th e in s u r a n c e com pany. Fortunately, n ot all insurance c o m p a n ie s a re as lazy. It is o b v io u sly easier for the insurance com pany to treat all providers w ith suspicion th an to roll u p its sleeves a n d id e n tify th e few p ro v id e rs w h e re s u s p ic io n m ig h t be justified. T h is ca llo u s d isreg ard for the safety a n d w e lfa re o f p a tie n ts m ay w a r ra n t le g is la tiv e rem e d y , a n d th is ca n be explored by the ap p ro p riate agencies. M ARYE FELD M AN SECR ETA R Y C O U N C IL O N D E N T A L CA RE PR O G R A M S
O ral ca n d id ia sis and A ID S □ O ra l c a n d id ia s is (th ru s h ) is o n e of th e m o st c o m m o n m a n if e s ta tio n s of ac q u ired im m u n e deficiency syndrom e (AIDS) an d AIDS-associated co n d itio n s.1'2 It m ay be th e i n it ia l s y m p to m in an o th e rw is e h e a lth y in d iv id u a l w h o is s e ro p o s itiv e fo r h u m a n im m u n o d e f i ciency virus (HIV ) or may ap p e ar su b sequently at different stages in patients w ith p e rsis te n t g en eralized ly m p h ad en o p ath y , A ID S-related com plex (ARC), an d full-blow n AIDS.3 T h is p ro s p e c tiv e stu d y in c lu d e d 89 h o m o - a n d b ise x u a l a d u lt m ales w h o are rec eiv in g a d o u b le -b lin d , placeboco n tro lled az id o th y m id in e p ro to co l for A ID S -associated K a p o si’s sarcom a. An o ra l e x a m in a tio n w as d o n e a t 4-w eek in te rv a ls by an o ra l p a th o lo g ist. O ral th ru sh was classified in to different types a c c o rd in g to its c lin ic a l a p p e a r a n c e .4 S m ears w ere ta k e n a n d s ta in e d w ith periodic acid-Schiff (PAS) technique and e x a m in e d m ic ro sc o p ic a lly to c o n firm th e c lin ic a l d ia g n o sis by th e presen ce
T O
T H E
E D I T O R
J A D A devotes th is section to co m m en t by readers o n topics of c u rre n t interest to dentistry. T h e e ditor reserves th e rig h t to e d it a ll c o m m u n ic atio n s to fit a vailable space a n d req u ires th a t all letters be typed, d ouble-spaced, a n d signed. N o m ore th a n ten references sh o u ld be given w ith each letter. P rin ted c o m m u n icatio n s do n o t necessarily reflect the o p in io n o r official policy o f the A ssociation. Y our p a rtic ip a tio n in th is section is invited.
P a y m en t for care □ In regard to the article by Drs. T ryfon B eazoglou, A lbert G uay , a n d D ennis Heffley (April), it should be pointed out that there is an o th er model of the fee-forservice system still used by m any of us today:
It is still ju st as acceptable to expect patients to pay for their dental care directly to the treating dentist as it is for grocers to expect direct paym ent at the end of our weekly sh o p p in g trips. T h e relatio n sh ip o u r patients have w ith their em ployers and any of n u m e ro u s th ird -p a rty insurers sh o u ld have n o th in g to do w ith the relatio n sh ip they have w ith their freely chosen dentist. T h ere are a nu m b er of p u re direct reim bursem ent plans aro u n d the country th at co n tinue to recognize the distinction between the doctor-patient relatio n sh ip an d the p a tie n t-th ird - p a r ty - e m p lo y e r relationship. C H A R L E S G . LEW IS. DDS M ULESHOE. TX
In su ran ce c o m p a n y p o lic ie s □ I w rite to you as a p h y s ic ia n , as a p atien t w ith his share of dental problem s, and as a p articip a n t in the dental plan of . . . insurance com pany to solicit your 818 ■ JADA, Vol. 116, June 1988
h e lp an d advice re g a rd in g a m a tte r of concern. I refer to a com p an y ’s req u ire m ent that all claim s for paym ent of dental expenses be accom panied by radiologic evidence that the w ork has indeed been com pleted. T h is req u irem en t forces the dentist to take costly, unnecessary, an d potentially hazardous radiographs. I su b m it th a t a lth o u g h the risk may be m in im a l even if c u m u la tiv e , th e ‘'m ax im u m safe dose” of ionizing ra d i ation is a statistical and n ot an absolute concept and th at, therefore, there is no excuse for ex p o su res o th e r th a n th o se dictated by professional judgm ent. T h u s, th e o n ly m o tiv a tio n s a p p e a r to be a s h o r tc u t to p a p e rw o rk a n d a d is tru s t of th e d e n tis t, th e p a tie n t, a n d th e ir records and statements. W hat is the p osition of the Am erican D ental A ssociation on the use an d abuse of ra d io g ra p h s ? W h a t ca n we d o to convince the insurance com pany to stop this practice? P IE R O P. FOA, MD. ScD W AYNE S T A T E U N IV ER SITY
□ C om m ent. T h e A m erican D ental Asso ciatio n ’s policy on the use of radiographs c o n ta in s 16 g u id e lin e s for th ird -p a rty payers and dentists. T h e p ertin en t g u id e lines include: 2. T h e use of rad io g rap h s sh o u ld be only for d eterm in in g the extent of lia b ility of th e p ro g ra m s a n d in n o case s h o u ld in f r in g e o n th e professional ju d g m en t of the dentist o r o n th e d e n tis t- p a tie n t r e la tionship. 12. P a tie n ts s h o u ld be e x p o se d to radiation only w hen such exposure is clinically necessary as determ ined by th e a t te n d in g d e n tis t. R a d io g r a p h s s h o u ld n ev er be ta k e n to satisfy the a d m in istra tiv e re q u ire m ent of a third party. F or ex ten siv e d e n ta l tre a tm e n t, an d w hen in su ran ce co m p an ies an d service
co rp o ratio n s have q u alified dentists on sta ff, p r e tr e a tm e n t r a d io g r a p h s are regarded as a second o p in io n —a practice used frequently in m edicine. However, p o sttreatm en t rad io g rap h s co n stitu te a “ g u ilty u n til proved in n o c e n t” sta te m e n t o n th e p a r t of th e in s u r a n c e com pany. Fortunately, n ot all insurance c o m p a n ie s a re as lazy. It is o b v io u sly easier for the insurance com pany to treat all providers w ith suspicion th an to roll u p its sleeves a n d id e n tify th e few p ro v id e rs w h e re s u s p ic io n m ig h t be justified. T h is ca llo u s d isreg ard for the safety a n d w e lfa re o f p a tie n ts m ay w a r ra n t le g is la tiv e rem e d y , a n d th is ca n be explored by the ap p ro p riate agencies. M ARYE FELD M AN SECR ETA R Y C O U N C IL O N D E N T A L CA RE PR O G R A M S
O ral ca n d id ia sis and A ID S □ O ra l c a n d id ia s is (th ru s h ) is o n e of th e m o st c o m m o n m a n if e s ta tio n s of ac q u ired im m u n e deficiency syndrom e (AIDS) an d AIDS-associated co n d itio n s.1'2 It m ay be th e i n it ia l s y m p to m in an o th e rw is e h e a lth y in d iv id u a l w h o is s e ro p o s itiv e fo r h u m a n im m u n o d e f i ciency virus (HIV ) or may ap p e ar su b sequently at different stages in patients w ith p e rsis te n t g en eralized ly m p h ad en o p ath y , A ID S-related com plex (ARC), an d full-blow n AIDS.3 T h is p ro s p e c tiv e stu d y in c lu d e d 89 h o m o - a n d b ise x u a l a d u lt m ales w h o are rec eiv in g a d o u b le -b lin d , placeboco n tro lled az id o th y m id in e p ro to co l for A ID S -associated K a p o si’s sarcom a. An o ra l e x a m in a tio n w as d o n e a t 4-w eek in te rv a ls by an o ra l p a th o lo g ist. O ral th ru sh was classified in to different types a c c o rd in g to its c lin ic a l a p p e a r a n c e .4 S m ears w ere ta k e n a n d s ta in e d w ith periodic acid-Schiff (PAS) technique and e x a m in e d m ic ro sc o p ic a lly to c o n firm th e c lin ic a l d ia g n o sis by th e presen ce