Forum Replies Created
-
AuthorPosts
-
Robert Gregg DDSSpectatorHow appropriate to have this Micigan Forum to talk about the latest:
We had a converence call with Dr Yukna yesterday and he told us that at the AAP, Dr. Mike Rethman “chased him down”. Rethman is the Chief Honcho for the Counsil on Scientific Affairs for the ADA. It was he who selected Dederich and Cobb to write the ADA statmens on Lasers and LANAP.
Apparently he has received “the word” that some respected and influential people are not please with his work product.
Ray said he was sheepish and apologetic in nature, like, “Please don’t be upset with me, I was just doing my job. We are just saying we need more research…..”
To that Ray said, just be sure that you apply the same standards of rigor in research requirements of the other perio products and techniques we use in perio that you apply to LANAP. Ray continued, You know as well as I do that many if not most of the products we use in perio don’t have the amount and type of research that you are demanding for LANAP.
Ray said that Rethman said, “Yeah, yeah, I know.” And walked away.:p
It’s just a matter of time…..
Bob
Michael AielloSpectatorDoes anyone recently put on Focused Review have any news to report? I’m especially curious to find how Delta handles the payment issues from the past LANAP cases that they review.
In my case, Delta did not ask for money back for cases prior to Focused Review. They did refuse to pay for future LANAP or anything that was not strictly “traditional” or “non-laser” surgery.
I have not heard anything new from the Insurance Commission regarding my official complaint. It is now four weeks since they sent me a letter telling me I would get a response (within four weeks).
Delta has taken a more aggressive stance within the last two weeks. I don’t know if there is any relationship with the Insurance Complaint. Previously they denied coverage for LANAP/Laser Surgery, but allowed me to bill the patients. Now Delta has sent new EOB’s that state I can’t bill these very same patients.
Delta’s reason: AP1490 Focused Review has disallowed this procedure because the required information was not received. Fee may not be charged to the patient if the dentist participates with Delta. The information Delta has meets their criteria for surgery. It includes the MDT bootcamp template and does not specify technique, use of laser vs scalpel, or methods used to modify bone.
adminSpectatorNo reply yet. Info sent approx 2 weeks ago registered mail to Delta
John LeitnerSpectatorWell, you could say I’m moseying along here on this one. We took off for the ADA meeting and gee – didn’t get to it right away. Now I got a note today saying I have 5 days or they will cut into future fees from my office. Interesting, what and were and how much will they take? Guess I’ll do it tomorrow, but I’ll write a nice note tonight first. John
sagoodellSpectatorInteresting. How do they even know that they might be wanting money back on any service since this is a “random” review? 😉
Who is the letter from?
John LeitnerSpectatorThe Delta letter was from Andrea Ruehle – provider auditor. uniform requiremtnt B-6 was the basis for the threat – we sent it today. John
Michael AielloSpectatorI spoke with the manager in charge of insurance complaints against Delta today. Her response was not good.
The Insurance Commission won’t be helping us out. Although I won’t be getting the official response for “weeks” the manager made it clear that the Insurance Commission doesn’t care or agree enough with us to pursue the matter in our favor.
John LeitnerSpectatorWell – my first question is do we need a tidal wave to get more noticable? How many Dr’s need to make them aware of the situation? So far – I believe Mike is the only one going down this road. If more ‘noise’ is made, will that help them to care?
John LeitnerSpectatorI just got a nice note from our friends at Delta questioning one of the patients I treated. Seems I treated her full mouth (with laser!) in one seating and they wanted me to clarify if that did indeed happen. I told them to read my notes and that it was reported correctly as all the information they requested was. Sheesh!!
dkimmelSpectator[youtube]http://www.youtube.com/watch?v=xxtUH_bHBxs[/YOUTUBE]
Testing
Michael AielloSpectatorIt wouldn’t surprise me if Delta denies your claim based on its guideline to reject D4260 if more than 2 quadrants are done in one day. This is listed in the guidelines that Bob Gregg posted in the main LDF.
Delta had been “creative” in its denial of my claims when I was originally put on focused review quite awhile ago.
The sooner we can get the ADA/MDA involved to help us the better.
Michael AielloSpectatorYou are right. We need to get as many MI LANAPers involved as we can. Contact me or Walt Goodell for the particulars. We need to send a consistent message that appeals to the ADA and MDA.
Mike Aiello
(O) 586 263-6800
(Cell) 586 260- 1204
email: mjaiello@yahoo.com
John LeitnerSpectatorWell, this was the patients desire due to family issues. The case has been paid by Delta (I know, they will just take it from future stuff sent in). See ya next FridaY?
adminSpectatorBelow, I’ve entered a rough draft of a letter to be sent to the Academy of Laser Dentistry. All critiques, corrections , and criticisms are welcome to help refine this before sending.
It was great meeting with all of you yesterday.President
Tony Hewlett, DDS
Stanwood, WA
360-629-4597
Fax: 360-629-6382
tony@drtony.netPresident Elect
Steven Burman, DMD
Manalapan, NJ
732-972-9950
Fax: 732-972-9952
drillnfill@aol.comExecutive Director
Gail S. Siminovsky, CAE
Coral Springs, Florida
954-346-3776 x 202
Fax: 954-757-2598
laserexec@laserdentistry.orgDear Leadership of The Academy of Laser Dentistry,
I am writing you today, to inform the leadership of the Academy of Laser Dentistry, regarding a current situation affecting laser dentistry in Michigan. If this situation is allowed to stand, there is no doubt in my mind, that it will adversely affect the practice of laser dentistry not only in Michigan but around the world. This situation sets a precedent of allowing insurance companies to dictate how procedures are preformed, as well as, with what instrumentation.
To bring you up to date, I’d like to present a little background information.
In Michigan, there currently are approximately 17 general practice dentists who use the Periolase and perform Laser Assisted New Attachment Procedure (LANAP). As you know, this procedure is patented and FDA approved. There also are four periodontists in the state who use the laser and also perform the procedure. The ADA has opined that the correct ADA coding for this procedure is 4260 (need to attach reference letter for this and reference here)
Over the last couple of years, eleven of the general dentists, have been placed under ‘random focused review’ by Delta Dental of Michigan with more being added each year. No specialist has been placed under this review. These dentists have been placed under ‘random review’ even though they have had prior approval of the procedure and met all of Delta’s guidelines and requirements for codes 4240 and 4260 (attach reference here)
During this ‘random’ focus review, each dentist has been required to submit all of the relevant notes and records regarding three ’random’ cases which all ‘just happen’ to involve codes 4240 and 4260. Upon review, Delta Dental has been either denying claims or disallowing them based on the new ADA position paper on lasers (see attachment). ‘Denying a claim’ allows the dentist to charge balance to patient and ‘Disallowing a claim’ prevents the patient from being charged for a procedure that has already been preformed by a participating dentist. Delta has decided, based on the release of this ADA postion paper, laser use in periodontics is ‘invesigational’ and thus not a covered benefit. They also have gone back and denied or disallowed 4260 and 4240 cases preformed before release of this new ADA paper.
These denials, not only set the bad precedent of reducing the amount of patients who can afford this proven procedure (place reference to Yukna/Tilt studies here) but also set a precedent of allowing insurance companies to dictate, to dentists, what instruments they can use to do certain procedures. This causes my colleges, and myself, great concern as it relates to laser dentistry.
While I am sure that, reading between the lines of this letter, you can see a potential turf war between periodontists and general dentists regarding the use of lasers in dentistry, and you should know there is more going on behind the scenes with connections within Delta Dental and former partnerships with periodontists, that really isn’t the primary concern of the affected general dentists here in Michigan. Our concern really stands with the ability of our patients to receive laser procedures, the freedom to use lasers in our practices, and the precedent this sets if allowed to stand.
Allowing this policy to stand, most certainly, will cause other insurance companies to adopt policies which are similar and will be detrimental to the advancement of the use of lasers in dentistry. It doesn’t take much imagination to see how the same policy could be put in place regarding lasers in endodontics or any other field of dentistry.
This fight also really has nothing to do with what anyone’s beliefs or history with Millennium Dental Technologies and LANAP, but really deals with the larger picture regarding the availability, and ability, to use lasers in dentistry to provide patients with the best care possible.
As a longstanding member of the Academy of Laser Dentistry, I am asking for your support for in fighting this obviously poor precedent being set regarding lasers in dentistry.
My colleges and I believe there are several ways you can support us and the use of lasers in dentistry:
1.Development of a position paper relative to the use of lasers in dentistry as equal or better than other traditional modalities.
2. Write to Delta Dental and the ADA regarding the inaccuracies in the ADA’s position paper that led to the ‘investigational label’ of LANAP and other problematic areas with in the paper (Yukna study was triple blinded and the study was second largest of its kind at that time, and other problems with the ADA paper relating to physics and various wavelengths in general).
My colleges and I thank you for your time and look forward in engaging with you to reverse the bad precedent being set in Michigan regarding laser dentistry.
Professionally yours,
Michael AielloSpectatorRon,
Upon a quick read it looks like a nice letter. I’ll post or email you some letters that might be helpful. Also note typo; colleges should be colleagues.
Let me know if you need anything else.
Mike Aiello
-
AuthorPosts