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John LeitnerSpectatorI’ve been emailing Norm Wilhelmsen some about what is going on with the focused review thing. He said the president of the MI periodontists has a laser and he is going to make contact with him regarding the laser usage. Also, he is thinking of having Ray Yukna come for the 2011 MDA meeting and speak. Not sure where this will go currently. It really was great to meet you all last week. Next time can we serve Kool-Aid? John
Michael AielloSpectatorJohn,
Concerning the laser angle to our argument, with your contacts I suggest that we stress that this is about the use of lasers not LANAP. If you need any copies of the Delta rejection letters let me know. These letters clearly show that Delta will not “accept” anything new if it deviates from the method they (not the ADA) determine is required.
Delta likes to cite the AAP and ADA position paper but they ignore the ADA direct response to them as well as this from the AAP website:
Will my insurance carrier cover the use of a laser in periodontal therapy?
Insurance carriers reimburse for the procedure being performed rather than the device used to perform it. Therefore, whether your periodontist uses traditional tools for treatment or lasers, your reimbursement will be the same for that specific procedure. Before having surgery, always consult with your insurance carrier to determine what procedures are covered in your plan.
Mike
John LeitnerSpectatorHi Mike – actually I thought it was the ‘osseous’ part of the procedure they are hitting on (which is the ultrasonic nicking). Not so much the ‘laser’ part of it – I must be tired tonite – correct me if I’m wrong. I know – no cutting, no sutures, and that stuff. Heck – I’ve got a patient with Metlife that didn’t have lanap and 5mm pockets and bleeding all over that was ‘refused’ treatment payment because of lack of need by the company. Go figure! John
Michael AielloSpectatorDelta has put in their rejection letters that all of the following is needed: 1) Full thickness flap with scalpel 2) Appropriate osteotomy or osteoplasty of alveolar bone and 3) Flap incision wound closed with suture needle and suture material.
Apparently, even if you lay a full thickness flap with anything other than a scalpel that is reason enough for denial. Same goes for stabilizing or closing flaps with anything other than sutures.
At this time don’t expect any help from the ADA. I had a few discussions over the last two weeks with people that represent the ADA Council on Dental Benefits and they don’t feel the ADA can do anything about this unless ADA legal takes it up. Per the representatives of the the Benefits Council, ADA legal won’t take it up since there is not enough dentists effected.
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