аЯрЁБс>ўџ 57ўџџџ4џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџьЅС'` №П0bjbjыШыШ ."‰Ђ‰Ђ0џџџџџџЄЄЄЄЄЄЄЄИ@ @ @ @ L ИkЖl l l l l l l l ъьььььь$!h‰|Є8 l l 8 8 ЄЄl l %x x x 8 Єl Єl ъx 8 ъx x ЄЄx l ` ЋЛћ;Ъ@ N x ъ;0kx X x Є† dl Š Ьx V Єњ >l l l n l l l k8 8 8 8 ИИИМ„ИИИМИИИЄЄЄЄЄЄџџџџ Dear Cathy, Here is an update on the issue with Delta Dental and it refusal to cover the periodontal surgery you had last winter. Delta Dental has decided to not allow coverage for the periodontal treatment that involves the use of the PerioLase laser. Although Delta did previously pay for this treatment with other patients they now have a policy that it is not a covered benefit. This is only a problem in Michigan for patients who have Delta Dental as their benefit administrator. No other insurance company in the country has denied these benefits. Since you previously asked me what could you do to help get this matter resolved, I have attached an insurance complaint form you could submit to the State of Michigan. In addition you could contact the Benefit or Human Resources representative at your employer and explain the situation to them. It is important to have them realize they and you are paying for a level of benefits which is not being provided for by Delta. If this representative would like to speak with me, I would be more than willing. As I had discussed with you previously when this issue with Delta came up, the American Dental Association (ADA) has been working with us to resolve this problem. The ADA is considered a neutral party in this matter. When the ADA was informed of this issue they contacted Delta. The Director of the ADA Council on Dental Benefits requested Delta to submit their questions in writing as to why Delta felt it was inappropriate to use the billing code 4260 Osseous Surgery for the type of periodontal surgery we performed on you. Enclosed is the official consensus response from the ADA. This response supports our position that it is appropriate to use the ADA insurance code 4260 Osseous Surgery for the treatment we performed. As previously mentioned this code 4260 is being used throughout the country with only Delta of Michigan deciding it is not covered for the treatment we performed. When Delta started to deny payment for this treatment using code 4260 they implied it was inappropriate to use this code. After the official response from the ADA, Delta has stated it now is not covered because the treatment is “investigational.” I strongly disagree with this position since your treatment meets the ADA’s criteria for using this code and your policy covers code 4260. The ADA Council on Dental Benefit Programs is recognized as the official source for clarification of proper use of dental insurance codes. It is the ADA that owns and created the codes that the insurance companies are bound to follow. The insurance companies and dentists are not supposed to redefine or recreate new definitions of these codes. As your dentist, if I perform a procedure and bill it, it is my responsibility to use the correct code for the treatment. In your case this was code 4260. We have been actively dealing with Delta Dental for over a year on this matter with no resolution. Currently we have a complaint filed with the Office of Financial and Insurance Regulation of the State of Michigan. If this does not provide resolution we will go to the next level and contact the State Attorney General and the Federal Trade Commission. Please let me know if anyone you contact would like a copy of the FDA approval or the science behind this treatment. There is ample evidence which clearly shows this is not “investigational.” Needless to say, based on almost five years experience, performing this FDA approved procedure I am still amazed at the outstanding results it provides and believe patients should not be denied its availability because of a dental benefits provider’s reversal of a previously approved procedure code. I appreciate your assistance in this fight. I appreciate the confidence you placed in me when you allowed me to provide treatment for your periodontal disease. Please know that we will continue to fight tirelessly to try and get this expected decision reversed. If you have any questions, or if we can be of any assistance to you with your interactions with Delta Dental, please feel free to contact me. 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