My letter to the insurance commissioner of Pennsylvania, still in draft form I may edit further:
Teresa D. Miller
Insurance Commissioner of Pennsylvania
Pennsylvania Insurance Department
1326 Strawberry Square
Harrisburg, PA 17120
Dear Ms. Miller:
Thank you in advance for your attention to a vital matter that affects the oral health of the citizens of Pennsylvania.
In the past two years, the United Concordia insurance company has embarked upon a program of consistent, spurious, groundless denials of both claims, and pre-determinations of benefits for, the treatment of periodontal (gum) disease.
In particular, they are denying payments on the grounds that there is no bone loss on dental radiographs. Yet in dentistry we have decades of scientific research that shows that:
(1) Periodontal disease is primarily diagnosed by clinical measurements. Dental radiographs provide further, supplemental information to the treating doctor, but are not the primary means of diagnosis.
(2) Periodontal disease is best treated early, before radiographic bone loss ever occurs. Early treatment is far less costly treatment as well.
In a recent email, attached, James B. Bramson, D.D.S., Chief Dental Officer of United Concordia Companies, Inc., specifically asserts, " Pocket depths are an important indicator of disease but do not necessarily indicate the presence of bone loss. Therefore, pocket depths alone are not an indicator of the need for PSRP." The abbreviation "PSRP" stands for the primary form of non-surgical treatment for periodontal disease, the treatment for which United Concordia is so consistently denying payment. They deny this treatment on the basis of not seeing bone loss on radiographs that we dentists present to them.
This assertion of Bramson's is utterly and entirely false in the light of all our dental science; in fact, it is an outright lie.
He is also placing the cart before the horse, as bone loss is a result of periodontal disease, and it increases with time and disease activity. Our goal in dentistry is to diagnose and treat periodontal disease before significant bone loss occurs. We do not wait until bone loss occurs, and allow the disease to become severe, and then embark on a course of treatment.
If I rephrase Bramson's statement to make it apply to another disease, you will see its absurdity. "Heart attacks and strokes are an important indicator of disease but do not necessarily indicate the presence of atherosclerotic arterial disease. Therefore, heart attacks and strokes alone are not an indicator of the need for angioplasty and stents."
Does that make any sense to you at all?
On behalf of the dental profession in Pennsylvania, I ask you to investigate and bring corrective action against United Concordia for this flagrant violation of the fiduciary responsibility and trust that they owe to their subscribers--Pennsylvania companies and the employees they enroll--who have paid so very much in premiums for scientifically justified services that are being stolen away from them.
Rick Wilson, D.M.D.