COUNCIL ON DENTAL PRACTICE



FINAL

COUNCIL ON DENTAL PRACTICE

December 4, 2009

PDA Central Office

A meeting of the Council on Dental Practice (CDP) was held at PDA Central Office on Friday, December 4, 2009. The following individuals participated:

Present Consultants/Staff/Guests Present

Dr. Bruce Parker, Chair (10) Matthew DiLoreto, Government Relations

Dr. Thomas Donahue (3) Coordinator

Dr. Joseph Yatko (6) Dr. Lauri Passeri, ADA Consultant (2)

Dr. Robert Callahan (7) Dr. Donald Stoner, Trustee Liaison (10)

Dr. Tad Glossner (5) Camille Kostelac-Cherry, CEO

Dr. Ronald Helminski (9)

Absent

Dr. James O’Larnic (1)

Dr. Frank Zarutskie (4)

Naila Naseem-Elkassas (8)

Dr. Jon Johnston (8)

Call to Order

The meeting was called to order at 9:39 a.m. by Dr. Bruce Parker.

Selection of a Meeting Scribe

Dr. Tad Glossner volunteered to be the meeting scribe.

Approval of Minutes

The council unanimously approved the June 26, 2009, meeting minutes.

Legislative and Regulatory Updates

Matt DiLoreto provided a legislative and regulatory update regarding PDA’s priority issues:

• Sen. Kim Ward’s introduction of legislation prohibiting insurance companies from capping fees for non-covered services or services provided after a patient has exhausted their annual allowance.

• Assignment of benefits legislation is expected to be introduced in the House.

• HB 1049, legislation providing for general anesthesia insurance coverage for children and special needs patients when needed for dental care was reported out of the House Insurance Committee but faces significant opposition in passing the full House and the Senate.

• A national trend toward regulating the practice of tooth-whitening in response to Alabama’s recent appellate court ruling.

• Dental hygiene scope of practice/supervision regulation.

Mr. DiLoreto indicated that PDA’s Board of Trustees and legal counsel are discussing the effects of the Alabama court ruling on Pennsylvania. PDA will publish information on hygiene regulations to the membership by the end of the year.

Presentation by James Shade – United Concordia

James Shade, Vice President of Professional Relations for United Concordia (UCCI) discussed UCCI’s contract amendment which caps fees for non-covered services or services provided after a patient has exhausted their annual allowance. Mr. Shade indicated that recent changes to UCCI’s executive staff, increases in the expected timeframe for the implementation of contract amendments, and other administrative changes factored into why contract amendments have been sent to participating dentists. Mr. Shade also presented a timeline as to how long this matter has been under consideration at UCCI.

Mr. Shade answered council members inquiries pertaining to: fee schedules, re- classification of services from “covered” to “non-covered,” coding matters and discrepancies, claim processing, annual fee evaluation, etc. Mr. Shade indicated that many questions were of a technical nature beyond his expertise and should be discussed with UCCI dental representatives. Mr. Shade agreed with the council that many insurance matters discussed were confusing even to him, and that many UCCI participating providers have similar concerns.

Mr. Shade encouraged the council to have dental representatives from UCCI attend the next council meeting, and invited the council members to visit UCCI as had been done previously.

Staff will research the financial implications of changing the Council on Dental Practice’s February conference call to a meeting in Harrisburg at PDA central office, or UCCI headquarters. (12/09CDPA1)

Dr. Lauri Passeri will draft a Transitions article summarizing James Shade’s presentation on UCCI contract amendments and his answers to CDP member’s questions about various insurance practices. (12/09CDPA2)

Staff will review Dr. Lauri Passeri’s draft Transitions article before distribution to the entire council, and then the PDA membership. (12/09CDPA3)

Miscellaneous Business – Member Requests

The council discussed four member complaints/letters regarding insurance concerns. Membership education is needed on what action the council can take legally regarding

many insurance concerns. Concern was voiced that members expect results that the council is unable to achieve.

Dr. Parker will draft a response letter to each PDA member inquiry. The letters will be reviewed by PDA staff and/or legal counsel before distribution. (12/09CDPA4)

The council unanimously approved Dr. Tad Glossner (5) as the next chairman of the Council on Dental Practice, succeeding Dr. Parker whose term expires in April 2010 (12/09CDPA5)

Dr. Passeri indicated that at a recent ADA conference the Insurance Solutions electronic newsletter was discussed and supported as a positive member benefit.

PDA staff will research the cost and possible benefit of purchasing the Insurance Solutions Newsletter, which staff may utilize to assist PDA members with their insurance billing inquiries. (12/09CDPA6)

Meeting Date

The council postponed scheduling the 2010 meeting or conference call date(s) until it is decided whether the February meeting will be a conference call or a visit with UCCI representatives in Harrisburg.

Adjournment

The meeting was adjourned at 12:52 p.m.

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