Letters: Delta's disallow policy
June 20, 2016
I was very disheartened to read the response from Dr. William Kohn in article "Association Asks Delta Dental to Reject Proposed Disallow Policy
," in the May 16 issue of ADA News. When a request is made to a dental benefits provider for clarification of or information regarding criteria for specific processing policies, the request should be honored and a respectful answer should be given. The response is expected to be supported by statistical and scientific data and not simply be a "because" response.
It is well known that many dentists do not agree with processing policies set by dental benefit providers. Some of this is based on individual ego but in most cases it is due to a lack of understanding as to what criteria is used to make benefit determinations. If the dental benefit providers could simply explain their rationale it would be much easier to understand and in some cases, accept their decisions.
In this specific situation the ADA is asking for reconsideration of a processing policy which (from one point of view) appears to benefit only the dental benefit carrier. If Delta Dental and other carriers would simply provide evidence or statistics to support their processing policies it might be easier for dentists to accept the decisions carriers make toward benefit determinations. When carriers keep the answers hidden, like Dr. Kohn has chosen to do in this case, it benefits no one and puts further strain upon the professional relationship between both parties.
Andrew Gazerro III, D.M.D.
Chair, Council on Dental Benefits, Rhode Island Dental Association
West Warwick, Rhode Island