ADA News

MetLife has hired consultants in India to review U.S. dental claims, angering some dentists who believe that the claims should be handled domestically.

In a letter sent in January to all MetLife consulting dentists, Dr. Brian Fitzgibbons, manager of MCR clinical for MetLife, announced there are not enough consultants in the United States to handle all of the claims, and the company was unsuccessful in recruiting more.

"This has been researched, and because we cannot obtain acceptable space locally, and MetLife is a global company, it has been decided that our new MCR panel will be formed at the MetLife facility in Noida, India. Noida is located just outside of Delhi," Mr. Fitzgibbons wrote.

The ADA's Council on Dental Benefit Programs takes issue with this practice, believing U.S. claims should only be reviewed by U.S. dentists. Additionally, in an era when more claims are auto-adjudicated, there should be a decreasing demand for claims review, which has dentists questioning the argument that there are not enough consultants.

"We have a policy that states that those people who are reviewing and denying claims should be U.S. dentists, preferably from the same jurisdiction that our practicing dentists are from, with the same credentials, same degree, etc.," said Dr. Bert Oettmeier, chair of CDBP.

That idea is important because dentists trained in foreign countries may be trained differently than in the United States, Dr. Oettmeier said.

"We're biased, but we think that the U.S. training is probably superior to most other countries," Dr. Oettmeier said.

The ADA view is that there is good reason why Commission on Dental Accreditation—accredited education is required for licensure in the United States.

MetLife officials refute the idea that their offshore consultants are less qualified than those in the United States. The company refused requests for a phone interview but provided an explanation of the process through an e-mailed statement.

"[Our] resources include licensed dentist consultants located both inside and outside of the United States who provide a clinical benefit opinion based upon submitted documentation," wrote Dr. David Guarrera, vice president of MetLife's Dental Product Management. "It is important to understand that our dentist consultants, both domestic and abroad, are all held to exactly the same United States clinical review standards, protocols and quality assurance metrics for all claims. In addition, any review that would result in a recommendation for a benefit denial or alteration can only be made by a U.S. licensed dentist, located in the United States. Dentists outside of the U.S. can only provide clinical benefit approval recommendations. All other clinical reviews are referred to a licensed U.S. dentist, in compliance with all applicable federal and state laws."

Mr. Fitzgibbons' letter states the Indian consulting dentists had gone through "an extensive selection process, are clinically experienced and have been personally interviewed by me." Once the Indian dentists have been trained, they would work the same as the U.S. consultants and be subject to the same standards "concerning reporting, review quality and production expectations."

At least six state dental association executive directors were sent an anonymous letter in March, informing them about MetLife’s new practices and urging them to learn about their state's laws regarding claim approval processes. Kevin Earle, executive director of the Arizona Dental Association, said if a MetLife consultant were going to review and deny claims, he or she would have to have a dental consulting license in Arizona.

"Most of our members would say the standard of care would be different in India than the standard of care in the United States," Mr. Earle said.

It's unclear whether the Indian consultants will strictly be reviewing dental claims or medical as well. The ADA is not aware of any other insurance companies employing this practice.

MetLife has been invited to the National Dental Benefits Conference scheduled for Aug. 19-20 in Chicago, and Dr. Oettmeier intends to discuss the foreign consultant issue, if the invitation is accepted.