UNITED HEALTHCARE REVISES D4910 POLICY - 02/01/2010
Dental teams and their patients will be pleased to learn that United Healthcare has revised its periodontal maintenance policy and no longer limits payment for D4910 to within the first two years following active therapy. The revised policy is currently effective for all new fully insured United Healthcare dental plans. Existing plans are being converted as their contracts come up for renewal. This should result in fewer D4910 denials for many United Healthcare members in 2010.
According to Michael Weitzner, DMD, MS, Vice President of National Clinical Operations, United Healthcare's standard D4910 policy language now reads: "Limited to two times per consecutive twelve months following active or adjunctive periodontal therapy, exclusive of gross debridement."
This means that United Healthcare's fully insured plans will cover D4910 twice per twelve consecutive months following periodontal scaling and root planing (D4341/D4342), osseous surgery (D4260/D4261), or a prior periodontal maintenance appointment (D4910). Also remember that self-funded dental plans are not required to adopt United Healthcare's new standard policy for D4910. You may encounter self-funded United Healthcare plans that still deny payment for D4910 when performed more that two years after active therapy. If this happens, explain to your patient that his/her employer has adopted an unusually restrictive policy in its dental plan that does not make sense from a clinical management point of view, and encourage the patient to express concern to his/her Employee Benefits Manager.
Call Center Staff May be Unaware
Unfortunately, phone representatives at insurance call centers are often the last to learn about important policy changes. Do not be surprised if the person you speak with at United Healthcare's call center is unaware of the new policy that was adopted in September 2009. Take the time to appeal D4910 denials you receive due to the two-year active therapy limitation and attach a copy of our December 2009 article (page 7), highlighting Dr. Michael Weitzner's name and the new policy language. This should help United Healthcare staff locate their new policy and process the D4910 claims according to their new guidelines.
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DELTA DENTAL CLARIFIES LASER POLICY - 08/02/2010
An increasing number of dentists are using lasers to perform sulcular debridement (curettage) and ot ...more
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Insurance Solutions,
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Thank you again for doing such a great job!
Shelly Ryan
Minnesota
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