IDA Dental Benefits Subcommittee periodically communicates with Dr. Jeff Johnston, Vice President and Chief Science Officer of Delta Dental of Michigan, Ohio and Indiana. As a result of this relationship, it was recently learned that beginning September 1, 2018, Delta Dental will implement a national claim processing policy limiting benefit coverage for intraoral bitewing radiographs to two bitewing images per benefit period for patients under age 10. Benefit payments for additional bitewing radiographs are disallowed unless approved by consultant review. The policy was developed in accordance with the ALARA principle (As Low as Reasonably Achievable) to minimize radiation exposure for children.
Concerns were expressed that there are many cases where 3rd and 4th bitewings are medically necessary and this new policy will be disruptive in administrating claims. Dr. Johnston assured us that he has reviewed this policy implementation with his consultants and they are to pay claims including 3rd or 4th bitewings when remarks documented by providers support medical necessity of additional images (i.e. to open a contact, unusually large mouth).
The Dental Benefit Subcommittee will continue to work on our members’ behalf in representing provider concerns to insurance carriers.