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Robert Gregg DDSSpectatorThanks Mike,
I stand corrected. It is Dr. Fleszar that I should have identified, not Dr McCellen. However, the point remains the same, if not worse as Fleszar is the Delta CEO.
Bob
Robert Gregg DDSSpectatorI have attached the highlighted version of the ADA’s letter to Delta of MI.
It places the authority to code for procedures under the discretion of the dentist, not Delta, even for LANAP.
I recommend including this letter with any documentation to patients, HR Departments , and legal authorities.
Bob
Robert Gregg DDSSpectatorExactly Mike,
And itis the “after-the-fact” targeting and discriminating reviews that will legally problematic for Delta MI. It shows that the only way to have identified the doctors submitting for LANAP reimbursement were NOT identified through claims review, but other means and methods that are inappropriate for the legal provisions of claim adjudication (i.e Dr. Jeff Jonston’s witch hunt).
Essentially, everyone has been put on a “black-list” because they render a service that is FDA approved and has refereed published literature. Not to mention that every other Delta plan is paying for LANAP, some who took previously strong atiLANAP postions like HDS (Delta of Hawaii) and Delta of Tennessee.
Bob
Robert Gregg DDSSpectatorAttached please find the letter from Delta of Tennessee to Dr. Skinner, our letter to their CEO, our letter to FTC, and a the confirmation of complaint from the FTC’s website.
The Director’s at the FTC have changed since my letters–and from what I understand, for the better. They are much more likely now to take an aggressive stance against entities with “monopoly power” or engage in a “pattern of behavior that is anti-comeptitive”, or a conspiracy between two or more people to restrain competition (e.g. for professional services).
In the Days of President Bush, the threshold for FTC involvement had to be evidence of 90% monopoly power in a market space AND ant-competitive behavior.
Reports from observers now indicate that under President Obama, the new FTC Chairman has stated the threshold for FTC action will be evidence of 51%market space monopoly AND anti-competitive behavior (restraint of trade, restraint of professional services, restraint of competition).
This is good news for us all in this case of LANAP. The observers indicated that the FTC will be even more aggressive once the evidence of monopoly exceeds 51% than the Bush Administration’s FTC even when the 90% threshold was reached.
Carpe Diem!
Bob
Robert Gregg DDSSpectatorAttached please find MDT’s press release and our letter to ADA President Dr. John Findley.
What is especially interesting and encouraging is that a very good friend and colleague of Dr Findley is a periodontist and a LANAP dentiost who is a huge fan.
While I cannot share with you the letter that was sritten to Dr Findley from this periodontist, it was blunt and to the point–the critics of LANAP are wrong.
Dr Findley proceeded to write a hand written note that I have a copy of (but cannot distribute) stating that he was “headed in the opposute direction” before hearing from our LANAP periodontist. While Findley didn’t say he would change the statment, it is a sign that we have friends with influence and they are speaking up.
Bob
adminSpectatormikea;56497 wrote:Ron,I don’t know if Delta will request money back. When I was put on focused review they said they found some cases that they paid that “in retrospect” they would not pay going forward.
For me, Delta did not demand any money back, they just refused to pay for 4260 going forward. It may interesting to see what they do now. If they allow you and others to keep the payments from claims prior to focused review this may raise more questions. It would be another possible example of selective enforcement since they haven’t paid us over the last year and a half (while on focused review) during the same time span.
Obvoiusly this isn’t a question I would raise to them being that it may put others at risk. On the other hand it is good to know for building our case. After all Delta had other means to notify dentists of their LANAP position rather than after the fact focused review.
So,Mike, would you hold off on sending my letter?
Also, how are you handling Delta patients since they’ve told you upfront they won’t pay?
ddockhamSpectatorWhat should we be doing to help speed up the change in Delta to better help our patients get the treatment they need?
Dave
ddockhamSpectatorDavid Dockham, DDS
800 North State Street
Stanton, Michigan 48888
(989) 831-9200 (O)
(989) 235-6090 (H)
(989) 763-6323 (C)
E-mail dr_dave@dockhamdentalcare.com
http://www.dockhamdental.com
Michael AielloSpectatorHere’s a draft of my version of Ron’s letter that I’m sending to some patients. I will enclose the ADA letter and copies of the Ins Commission forms. The forms will be partially filled out to make it easy for my patients.
File attachments:
Michael AielloSpectatorRon,
I would hold off on your letter until you know if Delta will try to recoup the payments. My guess is they won’t, since this will keep the patients from filing insurance complaints.
You may want to rework your letter or use my version of it when you run into any payment denials.
In my case Delta did not request money back, but they did refuse to pay on cases submitted after the effective date of focused review. They use date of receiving claims, not date of treatment.
For my Delta patients now, I’m telling them that SRP portion will be covered. You can submit this bypassing Focused Review. They are informed of the exclusive fight with Delta. The choice is accept lower coverage with SRP or submit 4260 to Focused Review with the hope that we get a favorable decision prior to Ins time limitations expiring. Otherwise we treat it like no insurance.
Unfortunately, I heard some dentists are not doing LANAP on their Delta patients.
A bigger problem is one case I have with dual insurance where Delta is the primary. I can’t figure out how to get the secondary to pay without involving Delta claim denials. In the back of my mind I am thinking Delta would like another carrier to see their rejection to raise red flags and have the secondary company look into joining their position.
For the above case mentioned, I’m awaiting the Ins Commission response prior to further action. As soon as I get the response to my complaints I’ll contact Bob and post.
wagoodellSpectatorWalter A Goodell, DDS
600 E Grand River Ave
Suite 4-A
Brighton, MI 48116810-227-2121 office
810-227-0961 fax
517-223-7393 home
248-890-8462 cell
Robert Gregg DDSSpectatorWell, David,
It really depends on you and what your interest level is.
In 1987 or so, The Travelers sent out letters to 50,000 dentists saying that they were doing too many procedures based on other dentists in the zip code. Oral surgeons were told they were doing more extractions than other dentists. Periodontist were told that they were doing more perio surgery than other dentists. They made no distinction between specialist and GP.
It was the first attempt at profiling dentists with computers and it was a PR disaster for the Travelers. I’m not sure they ever recovered from that.
What many of us did, was to get the names of all the employers that had dental benefits contracts with The Travelers. We got our info from Trojan Dental at the time.
We circulated that list and we all wrote letters of outrage over this conduct by Travelers. Then the ADA got involved and also took a position–but only because 50,000 ADA members or so were being impacted.
We don’t have those numbers. But this is more than one or two, too. But it would be a mistake to think that ADA will not repsond if enough of you rise up in Righteous Indignation to anyone and everyone you can write to:
1. The National Delta Organization
2. ADA John Findley (he has stated he is of a different mind than before)
3. Employers with Delta MI contracts
4. The MI State Attorny General
5. The MI Dept of Insurance
6. The FTC
7. The AGD
8. TV news – we can help with a press release on the national news wires.
9. Get you patients to write letters to ALL of the above
10. Complain on Consumer Complaint websites
11. The AAPThis is ALL our fight, but you who are impacted te most have to take the initiative.
We have to create enough PR and economic and professional PAIN for Delta that costs them more than what they want to do to facilitate the desires of Dr F and Dr. JJ
You, David, Mike and others did a great job in starting with the ADA. They have given us something to work with. We have to build on it, and never stop until we win this battle.
Bob
Robert Gregg DDSSpectatorI think you need to submitt your claims and fight the denials.
Bob
Michael AielloSpectatorBob,
I should have been clearer. The situation of dual coverage mentioned in my post has been submitted and is being fought with Delta. My problem on this one a bit more complex. Since I’m fighting the denial with Delta they won’t send me a rejection on their claim form. Without the rejection, I don’t have anything to send to the secondary to allow the secondary claim to be processed. If the State Ins Commission rules in our favor then its all a non-issue.
My complaint to the Ins Commission goes beyond LANAP. It also has to do with Delta “judging” techniques and methods. Delta has clearly implied to me in writing that they won’t pay for 4260/4240 unless all the steps of traditional surgery are performed and anything else is “investigational.” To me this is a case of Delta redefining the code (among other things). I’m holding off responding to Delta’s request for “more descriptive information on my techniques and methods” until I hear from the Insurance Commission.
Since I won’t give Delta more information, they won’t send an official claim denial. What I do have is Delta’s 3 page letter telling me I did not provide enough information and that LANAP or laser based surgery is not covered. This letter implies LANAP is no better than SRP, is investigational, etc… It is not something I would send to another insurance company.
I feel Delta has enough information. The chart copy they have lists the procedures that I did via the current MDT charting template. Delta also has a letter from me stating I did modify the bone to a more physiological form. What they want is me to clearly state what devices I used and how they were used.
They have gone as far as asking me to tell them how much bone was removed.
Robert Gregg DDSSpectatorGot it Mike. Let us know how that goes.
Good Luck!!!
Bob
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