For AGD Constituent Use Only
Constituent Dental Care/Practice
Chairperson’s Resource Manual
September 2010
Originally Published: August 1992
Revised: November 1994
Revised: February 1997
Revised: March 1998
Revised: March 2000
Revised: March 2002
Revised: February 2004
Revised: March 2006
Revised: January 2007
Revised: September 2010
For AGD Constituent Use Only
Table of Contents
I. INTRODUCTION ......................................................................................................................................................5
II.
ALTERNATIVE DELIVERY/PAYMENT SYSTEMS ......................................................................................6
ANTITRUST REGULATIONS: .....................................................................................................................................6
SIGNING A CONTRACT: ............................................................................................................................................7
CAPITATION PROGRAMS: ........................................................................................................................................8
CAPITATION-SURCHARGE PROGRAMS: ..................................................................................................................9
DENTAL SERVICE CORPORATIONS: ........................................................................................................................9
DIRECT REIMBURSEMENT PROGRAMS: ................................................................................................................ 10
ELECTRONIC CLAIMS AND THE NPI REQUIREMENT: .......................................................................................... 10
FEE SCHEDULE PROGRAMS: .................................................................................................................................. 11
FLEXIBLE BENEFIT PROGRAMS AND CAFETERIA PROGRAMS: ............................................................................ 11
HEALTH MAINTENANCE ORGANIZATIONS (HMOS): ........................................................................................... 11
INDIVIDUAL PRACTICE ASSOCIATIONS (IPAS): .................................................................................................... 12
INSURANCE-FREE PRACTICES: .............................................................................................................................. 13
MANAGED CARE: ................................................................................................................................................... 13
MANAGEMENT SERVICE ORGANIZATIONS (MSOS): ............................................................................................ 13
PREFERRED PROVIDER ORGANIZATIONS (PPOS): ............................................................................................... 14
TABLE OF ALLOWANCES/FIXED BENEFIT PROGRAMS:........................................................................................ 14
USUAL, CUSTOMARY, AND REASONABLE (UCR) PROGRAMS:............................................................................. 15
III.
HOW TO RESOLVE CONFLICTS................................................................................................................. 16
SELF-FUNDED PROGRAMS: .................................................................................................................................... 17
AGD CHECKLIST FOR RESOLVING PROBLEMS WITH CARRIERS: ....................................................................... 17
AGD CHECKLIST FOR ................................................................................................................................... 18
RESOLVING PROBLEMS WITH CARRIERS .............................................................................................. 18
COMPLAINT REPORTING FORM: ........................................................................................................................... 20
AGD COMPLAINT REPORTING FORM ...................................................................................................... 21
PRE-APPROACH: .................................................................................................................................................... 24
Draft of a Pre-Approach Letter......................................................................................................................... 24
BENEFIT EXCLUSION CLAUSES: ............................................................................................................................ 25
Draft Response to Benefit Exclusion Clauses .................................................................................................. 25
LIMITATION OF BENEFIT BASED ON UCR: ........................................................................................................... 26
Draft Response to Limitation of Benefit Based on UCR ................................................................................. 27
WHEN A CARRIER CHANGES THE ORIGINAL TREATMENT CODE: ...................................................................... 28
Draft Response to a Carrier Changing the Original Treatment Code ............................................................ 28
DENIAL OF BENEFITS WHEN TREATING FAMILY MEMBERS: .............................................................................. 29
DENIAL OF PAYMENT FOR COVERED PROCEDURES PER THE CONTRACT LANGUAGE:...................................... 29
PROFESSIONAL COURTESY:................................................................................................................................... 31
LOSS OF RADIOGRAPHS: ........................................................................................................................................ 31
MISDIRECTED PAYMENT OF BENEFITS: ................................................................................................................ 32
PERIODS OF PATIENT INELIGIBILITY: ................................................................................................................... 32
PRE-DETERMINATION: ........................................................................................................................................... 32
REDUCED BENEFITS FOR NON-CONTRACTING PROVIDERS: ................................................................................ 33
TWO-TIERED REIMBURSEMENT SYSTEMS: .......................................................................................................... 33
Draft Response to Two-Tiered Reimbursement Practices ............................................................................... 34
UNRETURNED REFERRALS: ................................................................................................................................... 35
UTILIZATION REVIEWS: ........................................................................................................................................ 35
Draft Response to Utilization Reviews .............................................................................................................. 36
DRAFT RESPONSE TO MISINTERPRETATION OF COORDINATION OF BENEFITS .................................................. 37
DRAFT RESPONSE TO DENIAL OF BENEFIT FOR SEALANTS.................................................................................. 38
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DRAFT RESPONSE TO REJECTION OF CLAIM FOR OVERPAYMENT...................................................................... 39
DRAFT RESPONSE TO DENIAL OF BENEFIT FOR DENTIST WRITING A TOBACCO CESSATION PRESCRIPTION .. 40
AGD CHECKLIST FOR RESOLVING PROBLEMS WITH DENTAL PRODUCTS AND MATERIAL AND THE ............... 41
AGD CHECKLIST FOR RESOLVING PROBLEMS WITH DENTAL EQUIPMENT ............................................................ 41
AGD CHECKLIST FOR RESOLVING PROBLEMS WITH ......................................................................... 42
DENTAL PRODUCTS AND MATERIAL ....................................................................................................... 42
AGD CHECKLIST FOR RESOLVING PROBLEMS WITH ......................................................................... 44
DENTAL EQUIPMENT ................................................................................................................................... 44
IV.
WORKING WITHIN ORGANIZED DENTISTRY .......................................................................................... 46
CDT ........................................................................................................................................................................ 46
SELECTING A DENTAL BENEFITS PLAN................................................................................................................. 46
YOUR STATE DENTAL ASSOCIATION OR LOCAL SOCIETY ................................................................................... 46
PEER REVIEW......................................................................................................................................................... 47
V.
CURRENT AGD ADVOCACY POLICIES .................................................................................................... 48
Accreditation and Recognition of Non-Specialty Areas .................................................................................. 55
ADPAC .............................................................................................................................................................. 56
Advertising of Credentials ................................................................................................................................. 56
Advocacy Fund .................................................................................................................................................. 56
American Dental Association ........................................................................................................................... 56
Anesthesiology ................................................................................................................................................... 57
Annual Meeting ................................................................................................................................................. 57
Contracts............................................................................................................................................................ 57
Dental Anesthesiology ....................................................................................................................................... 58
Dental Auxiliaries ............................................................................................................................................. 58
Dental Practice .................................................................................................................................................. 60
Dental Consultant ............................................................................................................................................. 84
Dental Education .............................................................................................................................................. 84
Dental Laboratory Techniques ......................................................................................................................... 86
Dental Materials ................................................................................................................................................ 86
Dental Practices ................................................................................................................................................ 87
Dental Students ................................................................................................................................................. 88
Denturism .......................................................................................................................................................... 89
Direct Reimbursement....................................................................................................................................... 89
Dues ................................................................................................................................................................... 89
Enteral Conscious Sedation .............................................................................................................................. 90
Federal Services ................................................................................................................................................ 90
Fees .................................................................................................................................................................... 91
General Dentist.................................................................................................................................................. 91
General Practice Residency Program ............................................................................................................... 93
Geriatric Care .................................................................................................................................................... 94
Health Maintenance Organizations (HMO’s) ................................................................................................. 94
Health Planning ................................................................................................................................................ 94
HIV .................................................................................................................................................................... 94
Hospital Dentistry Privileges ............................................................................................................................ 95
Implants ............................................................................................................................................................. 95
Infection Control Measures Urged ................................................................................................................... 96
Infectious Waste ................................................................................................................................................ 96
Insurance, Malpractice ...................................................................................................................................... 97
Legislation ......................................................................................................................................................... 97
Licensing ......................................................................................................................................................... 107
Licensure ......................................................................................................................................................... 107
Limitation of Practice ..................................................................................................................................... 108
Malpractice Insurance and Litigation ............................................................................................................ 108
Mandated Health Benefits .............................................................................................................................. 108
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For AGD Constituent Use Only
National Health Program, Dentistry’s Position on ........................................................................................ 109
National Practitioner Data Bank .................................................................................................................... 109
OSHA ............................................................................................................................................................... 109
Patient Records................................................................................................................................................ 110
Pediatric Dentistry ........................................................................................................................................... 110
Peer Review Committees ................................................................................................................................. 110
Post Graduate Training .................................................................................................................................. 111
Public Information .......................................................................................................................................... 112
Radiographs .................................................................................................................................................... 112
Salaried Dentists.............................................................................................................................................. 112
Sedation ........................................................................................................................................................... 113
Smoking ........................................................................................................................................................... 113
Specialty License Laws.................................................................................................................................... 113
Specialty Listings ............................................................................................................................................. 114
State Board of Dentistry .................................................................................................................................. 114
Sterilization...................................................................................................................................................... 115
Surveys ............................................................................................................................................................. 115
Table of Allowances ........................................................................................................................................ 115
VI.
ACCESS AND PREVENTION...................................................................................................................... 116
AGD ACCESS TO CARE WHITE PAPER................................................................................................................... 116
PREVENTION .......................................................................................................................................................... 117
VII.
WORKFORCE / INDEPENDENT MIDLEVEL PROVIDERS ............................................................... 118
VIII.
AVAILABLE RESOURCES .................................................................................................................... 118
RESOURCE STAFF................................................................................................................................................. 118
2010-2011 AGD DENTAL PRACTICE COUNCIL................................................................................................... 120
RESOURCE MATERIALS ....................................................................................................................................... 121
STATE DENTAL ASSOCIATION CONTACTS, TELEPHONE NUMBERS, AND ADDRESSES ...................................... 122
STATE DEPARTMENTS OF INSURANCE ................................................................................................................ 129
MEDWATCH:........................................................................................................................................................ 140
FEDERAL AGENCY CONTACT NAMES AND ADDRESSES: .................................................................................... 141
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For AGD Constituent Use Only
I. Introduction
This manual is intended to assist you, the Constituent Dental Care/Practice Chairperson, in your
role as ombudsman for your constituent’s general dentist members. Yours is a critical role—you
are charged with collaborating with the Academy of General Dentistry’s (AGD) Dental Practice
Council. You must therefore understand the impact of any issue that might affect the dental
profession, the oral or related systemic health of the public, or the general practitioner’s right to
practice.
Today, more than ever before, the origins of issues affecting dentistry can have many sources:
consumers and consumer action groups; third party payers; national and state legislation and
regulation; and various health care organizations. As Constituent Dental Care/Practice
Chairperson, you have demonstrated that you are truly interested in and concerned about dental
benefit and dental practice issues that are facing the profession. Your responsibilities call for
you to share information, initiate inquiries and work with AGD Headquarters staff and/or
appropriate Dental Practice Council members relative to dental practice issues that are impacting
(or may significantly impact) the practices of AGD members in your constituent.
Specific responsibilities call for you to:
1. Be familiar with your state or provincial Dental Practice Act.
2. Keep your constituent informed about local dental practice and dental benefit issues, as well
as national issues as summarized in the Dental Practice Council Action Summaries that will
be forwarded to you within 30 days after each meeting.
3. Respond to constituent surveys and/or all other constituent outreach efforts by the Dental
Practice Council.
4. Encourage your constituent editor to regularly publish appropriate articles and relevant dental
practice information in your constituent newsletter.
5. Establish liaison with your state or provincial dental care and legislative committees.
6. Provide AGD Headquarters with appropriate documentation relative to the details of any
dental practice issues occurring on a constituent level, which are impacting (or may
significantly impact) the practices of the members of your constituent.
You may also want to become involved in implementing an appropriate constituent dental care
project. In many cases, this project should be accomplished in collaboration with your state or
provincial dental care and/or legislative committees.
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For AGD Constituent Use Only
II. Alternative Delivery/Payment Systems
General
Virtually every allied health care field has had to defend itself against public media coverage of
horror stories regarding the skyrocketing cost of care, provider abuse and the insurance
industry’s application of various “fix-it” techniques. Dentistry has not been spared this type of
negative coverage and, in fact, some would say that dentistry is a victim of this critical publicity
because more and more frequently, the cost containment mechanisms used in medical plans are
being applied to dental benefits programs with no regard for the most basic differences between
the two fields.
The big issue in insurance programs, particularly when it comes to dentistry, in which some
procedures are perceived as being wholly elective, is cost containment. Yet insurance companies
and insurance plan purchasers frequently fail to realize the most obvious difference between
dentistry and medicine—dentistry does not require coverage for catastrophic care. While total
medical/dental expenditures may account for an ever-increasing percentage of the Gross
National Product, dentistry’s share of the total dollars spent on health care dollars is minuscule.
Yet, as American businesses develop new programs to control health care costs, there is more
interest in designing and implementing alternative and less costly systems to deliver health care
to the public.
AGD membership surveys have indicated that many AGD members have participated in one or
more dental plans, including fee-for-service.
This chapter includes the basic points of various health care delivery systems. The information
presented here is intended to familiarize you with some of the plans currently available. It is
strongly recommended that any dentist considering participation in any plan conduct a careful
and thorough review of the program and its implications. Be aware that voluntary enrollment on
the part of the patient can lead to adverse selection, which means that people who need the most
care will enroll in greater numbers than those requiring a lower level of care.
Definitions on the following pages that are marked by an asterisk (*) are based on the definitions
contained in the Selecting a Dental Benefits Plan brochure published by the American Dental
Association’s (ADA) Council on Dental Benefits.
Antitrust Regulations:
Like other health care professionals, dentists (and dental organizations) are bound by certain
government regulations that can seriously restrict their activities or responses to situations
perceived as threatening. As an illustration, dentists are frequently approached by third party
carriers, which may appear to have great resources, to reduce or discount their fees, alter their
reimbursement mechanisms, or change their practice profiles. However, the dental practitioner
must be aware that certain reactions, such as price fixing, group boycotts, or even restraint of
trade, may result in violation of antitrust regulations.
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The penalties for these violations can be quite severe, including substantial fines, imprisonment,
and losing one’s license to practice.
Every practicing dentist should have at least a basic understanding of these terms and of the
antitrust laws and their enforcement mechanisms. The ADA’s Division of Legal Affairs has
issued a publication, The Antitrust Laws in Dentistry, which explains basic antitrust principles
and serves as a guide to what actions may or may not be taken when dealing with fees,
reimbursements, and third parties. The brochure is available free-of-charge to ADA members.
Signing a Contract:
When a dentist signs a contract to provide services, that contract is a legally enforceable
document with responsibilities and obligations that could prove onerous, especially if they were
not anticipated. To ensure that the dentist completely understands the terms and conditions of
any agreement before entering into a contract, he or she should have the contract reviewed by
legal counsel who is qualified to provide advice in this area.
It is not within the scope of this manual to detail every caution to be aware of when signing a
contract, but there are many questions that should be answered by the contract. The following
questions are for illustrative purposes only and should not be considered to be a complete list.

Is there a hold harmless clause? Do you incur liabilities if you sign it?

If you are not comfortable performing certain procedures, will specialty referral be allowed?
If so, under what conditions? Will you or the company choose the specialist? Will you be
financially responsible? If not, are there situations where you may become financially
responsible?

Do you control and determine treatment?

Under what conditions can you terminate the contract? Are you obligated to treat covered
patients after termination? If so, for how long and at what fees?

Will your name be marketed and advertised? How? Do you have prior approval?

What are the terms of payment? If the company does not pay you or stops paying you, are
you allowed to collect from the patient?

Are you responsible for charges by another emergency treating dentist?

Will you be subject to utilization review? If you must abide by it, will it compromise your
professional judgment?

Who owns and controls the company? What has been its track record?

Does the company have a recoupment policy—that is, can the company do a retrospective
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For AGD Constituent Use Only
review of your records to ask for a refund for procedures performed deemed unnecessary?
Dentists considering participation in an alternative delivery/payment system may wish to contact
AGD HQ at BenefitsAdvocate@agd.org for the AGD’s contract analysis service, which is free to
members. After receiving the analysis, dentists should share and/or review this information with
their personal attorney and/or financial advisor to determine whether the new program will fit
into their current dental practice. Additionally, the ADA also offers a similar program to
members for a nominal fee. You may contact the ADA Contract Analysis Service at
<http://www.ada.org/member/newdent/mancare.html>. However, priority is generally given
to contracts that are sent through the state dental association.
Capitation Programs:
In this type of program, contracting dentists are paid a fixed amount, usually on a monthly basis,
per enrolled patient or family. In return, the dentist agrees to provide a specific level of
treatment or scope of benefits to the patients as necessary.
Payment is based on the number of persons eligible for dental benefits during a payment period,
regardless of whether the subscribers receive treatment. Under certain circumstances,
subscribers may be responsible for a minimal surcharge or co-payment, usually for special
services involving dental laboratory procedures, oral surgery and periodontal surgery.
Subscribers may receive benefits only if treated by a contracting dentist. Once a provider is
chosen, the patient may be treated by only that individual or facility for the length of the
contract, often one year, except if a specific treatment in progress must be completed.
Capitation programs protect the plan purchaser from the possibility that the cost of benefits may
exceed projections by transferring the financial risk to the dentist, who is paid a set rate for the
length of the contract. Contracting dentists are usually responsible for referrals and costs
associated with specialty services or emergency care. Financial gain is realized only when actual
treatment costs are below the projected levels. For this reason, it is not to the contracting
dentists’ benefit if actual service costs exceed the level of capitation payments.
In many cases, substantially more care is required in the early months of the program in order to
establish a maintenance level of patient care. The participating dentist’s initial risk is that the
capitation payment will not cover the cost of treatment delivered in this first period. A
secondary risk is that this initial financial deficit may not be recovered if the patient changes
providers or if the plan purchaser does not renew the contract. It is also possible that the rates of
the renewed contract will be lower than the rates of the initial contract, thereby creating an
incentive to limit treatment, to withhold certain services, or to provide less expensive treatment
options to capitation patients. However, this practice could result in failure to provide necessary
treatment.
The aspects that seem to appeal to dentists who participate in capitation programs include
predictable periodic income, the cost savings realized from not having to devote staff time and
energy to completing claims forms (although some companies require encounter forms to track
your utilization), and monitoring account collection. There is also the possibility that joining this
type of program will increase the number of new patients, thereby creating a new source for
patient referrals.
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Some capitation programs require periodic reviews of patient records in order to evaluate and
monitor services rendered. In some instances, contracting dentists have had to modify their
record keeping systems in order to conform to the review requirements. Verification of patient
eligibility must be ongoing and may additionally disrupt your normal office routine.
Some practitioners feel that capitation programs deprive patients of freedom of choice and may
interrupt already-established provider-patient relationships and treatment plans. In some cases,
they may not allow adequate provision for specialist referrals and, under certain circumstances,
the capitation dentist may be asked to perform specialty services he or she does not typically
perform or he or she may be financially liable for the cost of specialty care.
Capitation-Surcharge Programs:
The Capitation-Surcharge Program model combines the fixed payment concept of a standard
capitation program with a limited modified fee-for-service payment structure with surcharges
allowed to be charged to the patients for certain procedures, for example, crowns and bridges.
Often these surcharges can be quite low, intending to cover all or a portion of laboratory fees. If
referrals are allowed, they may be limited to a specialist who also contracts with the capitation
program. Joining a capitation program requires serious thought. When signing any contract,
there are questions and issues to consider and be aware of, many of which should be answered by
the contract. Capitation programs vary from: the amount of paperwork involved; the restrictions
placed on the provider; the minimum amount of experience required to be enrolled; and the
different number of plans within a program. Although most plans capitate between 30 and 45
percent of the collected premiums, there are plans that capitate around 60 percent. You should
keep in mind that payment to the provider varies from plan to plan; some plans pay at the date of
enrollment, while others pay after the first office visit. When joining a capitation program, shop
around and choose the plan that best suits your needs.
Dental Service Corporations:
Dental service corporations account for a large percentage of the dental prepayment market with
plans that usually include contractual agreements with dentists who agree to provide services to
subscribers at pre-filed fees. Benefits in these programs are usually administered on a usual,
customary, and reasonable (UCR) fee.
The dental service approach provides benefits to subscribers in actual dental services, not as
reimbursements based on scheduled dollar amounts for each service. Participating dentists must
meet certain uniform requirements established by the corporation to ensure its fiscal stability.
Contracting providers usually are required to file confidential listings of user fees for each
procedure and may be subject to periodic in-office verification of those fees. These requirements
allow the corporation to know the dentist’s usual fee in advance and aid the corporation in
developing UCR programs. When fee filing is not required, the corporation identifies UCR fees
from the actual charges submitted on claims. The participating dentist receives benefit payment
directly from the service corporation and cannot charge the patient any more than the difference
between the accepted filed fee and the plan-paid benefit.
Of course, certain policies and procedures will differ when treatment is rendered by nonparticipating dentists, who are allowed to bill patients for any account balance, but patients may
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be reimbursed at a lesser level. To be successful, a service benefit program must have a
significant number of dentists within the state participating in the program. Contracting
providers agree to cooperate in quality assurance programs, including routine and selective posttreatment reviews and binding arbitration by state and peer review committees.
Some participating dentist agreements involve non-profit organizations, and require participating
dentists to accept limited financial risk—for instance, in the event that the service corporation
depletes its financial reserve, the provider may be required to complete treatment for the duration
of the contract, even though compensation may be reduced or eliminated.
Direct Reimbursement Programs:
The direct reimbursement dental benefit program is a self-funded, freedom of choice benefits
plan that eliminates the possibility that the plan sponsor will influence treatment decisions by
reimbursing claims to the patient as a fixed percentage of the amount spent on dental care,
regardless of the treatment category.
Subscribers receive dental care pay for their treatment immediately and then submit a receipt and
statement of service to their employers for direct reimbursement. Third-party carriers are rarely
involved in the process. Since the direct reimbursement benefits model does not involve a
middle-man, it benefits all parties involved by having the patient pay the dentist directly for
services. This process is streamlined, easy to administer, and theoretically, considerably less
expensive, with more dollars available for patient care.
This type of plan is especially easy for plan participants to understand because it is based on
actual dental expenses incurred. Another advantage of this model is that there is no need to
delineate covered services, which in some cases may negatively influence treatment decisions
and interfere in the provider-patient relationship. Patients are given the freedom to choose not
only their provider but the type and extent of oral therapy they desire. In providing treatment,
dentists are not limited by what services their patients’ plans cover. In addition, purchaser costs
are limited by cost sharing levels, modest annual maximums and direct payment by patients. By
not involving a third party, both the employer and the provider realize considerably lower
administrative costs.
A potential disadvantage exists in that depending on how the program is written, the patient may
have to first pay the dentist and then be reimbursed by the employer. However, the employer has
great flexibility in designing a direct reimbursement program and the ADA has extensive
information available to help in this regard.
Electronic Claims and the NPI Requirement:
Electronic claims submission is a growing trend in the benefits industry. For the participating
dentist, submitting claims electronically generally expedites processing and reimbursement by
the insurer. Often, electronic claims may be submitted through your office’s practice
management system or computer with an internet connection.
If a dentist chooses to implement electronic claims processing, he or she must be aware of the
requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
associated with it.
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HIPAA requires all “covered entities” to use a National Provider Identifier (NPI) for electronic
transactions. HIPAA states that, “Providers who transmit health information in electronic form
via standard HIPAA electronic transactions are considered covered entities.” All electronic
claims submitted (since May 23, 2007) must include the provider’s NPI.
The National Dental Electronic Date Interchange Council (NDEDIC) has posted detailed
information on its website (www.ndedic.org) about NPI and HIPAA that is relevant to general
dentists.
Fee Schedule Programs:
Under this benefit reimbursement model, participating dentists are required to provide services to
subscribers at fees that may be below those most frequently charged in the community.
Participants in this type of plan agree to accept the scheduled fees as payment in full and may not
collect the balance from patients.
Fee schedule programs are relatively inexpensive for group purchasers, may also be offered to
individuals, and may expand the participating dentist’s patient base. They do not allow
subscribers freedom of choice and may encourage selection of providers solely on the basis of
cost. In addition, by limiting the choices of providers, fee schedule programs may interrupt
already established provider-patient relationships and treatment plans. Some have claimed that
since participating dentists may reduce fees in order to increase the patient base, this type of
program may cause conflict between professional judgment and the need to generate revenue.
Flexible Benefit Programs and Cafeteria Programs:
Within the past several years, a number of corporations adopted flexible benefit packages, which
give employees the ability to choose between cafeteria plans and flexible spending accounts. In
the cafeteria-style plan, employees are given a specific dollar amount of benefits to “spend” on
any combination of benefits. This option allows employers to maintain a certain level of benefits
costs, while still meeting the specific health care needs of each employee. Frequently, when
employees select benefits from a cafeteria-style plan, dental insurance is selected only if funds
remain after selecting other options such as medical care, retirement plans, sick leave, disability,
and vacation benefits.
Another option in flexible benefit programs is the flexible spending account, in which employees
may reduce their salaries providing their employers use those funds for selected service expenses
approved in the Internal Revenue Service Code. General categories of allowed expenses include
medical, child care and legal costs. Participants may apply deductions towards such items as
medical expenses and co-payments. In the case of dental care, funds may be set aside to cover
the year’s co-payment; or, if the employee does not have dental coverage, funds may be used to
cover the year’s expected dental costs.
Health Maintenance Organizations (HMOs):
Health Maintenance Organizations (HMOs) deliver comprehensive health services, stressing
preventive care, to a group of subscribers at a single premium. Since the HMO serves as both
provider and insurer, it assumes the risk that the cost of treatment rendered may exceed the
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premium paid by subscribers. This delivery system is often less costly to plan purchasers than
traditional insurance packages. Purchasers pay a set premium to the HMO to cover their
subscribers, who in turn select a primary care provider from the list of individual providers
contracted by the HMO.
The single premium per individual or family is designed to cover the cost of care to all
subscribers, regardless of how often they use the plan. Providers are paid either a flat rate for
each patient regardless of the amount of care provided, or are paid according to the number of
patients seen in a given time period. Referral to specialists or hospitalization can be ordered only
by the primary care provider. The principle economies perceived through this delivery system
relate to reduced hospital days per annum for insured populations. Some critics express concern
that HMOs may undertreat patients since they make the most profit by delivering less treatment.
Some HMO managers claim patients often overuse services because they pay little or nothing for
the care they receive. Some physicians formerly associated with HMOs report they felt
pressured to give too few tests and too little treatment and were required to deal with
administrators who tried to influence medical decisions. Some HMO subscribers claim that there
is a long wait for appointments and that they can receive treatment from specialists only if they
are referred by their HMO provider or if they personally pay the specialist’s bill. While the
HMO concept is geared more toward medical care than dental care, some HMOs are including
dental plans as a means to build their business.
Because hospitalization is rarely a factor in the delivery of dental care, the HMO model is not
believed to offer greater savings in the provision of dental care. Generally, under HMO dental
plans, diagnostic, preventive and basic restorative services are provided at no charge to the
patient. Depending on the plan’s design, patient surcharges, expressed as a dollar amount, may
be imposed for more extensive services such as crowns, bridges, surgery, dentures and
orthodontics. Under certain circumstances, dentistry can be delivered under an HMO-type
model and often this is referred to as “managed care” (however, managed care can be found
under a variety of other models as well). This type of managed care calls for a “personal” dentist
to develop patient treatment plans, including any “specialty” services that may be needed, but
can be delivered only if approved by the third-party carrier, and may be performed by a
“specialty” dentist. Depending upon the plan, “specialty” services may include a variety of
procedures: endodontics, oral surgery, periodontics, and IV sedation and general anesthesia.
Frequently, orthodontic appliances and services are considered a completely separate category
and are administered under a separate insurance rider with an individual lifetime maximum.
Another category can be HMOs that employ salaried dentists. These closed panel systems are
established when patients, eligible for services in a public or private program, receive services
only at specific facilities by a limited number of providers. Often, the closed panel directly
assumes the financial risk of providing care within the premium income of the plan, and receives
compensation based on a fixed amount for each beneficiary, similar to a capitation plan. In other
instances, closed panel participants are reimbursed through a salary, percentage of gross, fixed
fee, or combination basis.
Individual Practice Associations (IPAs):
Individual Practice Associations (IPAs) consist of groups of practitioners, usually practicing
individually, often with an administrator, which contract with a purchaser of dental benefits in a
manner that is designed to be more economical than conventional delivery systems for both the
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purchaser and group members. Involved dentists usually agree to provide treatment to eligible
subscribers at fees below those most frequently charged in the community.
IPAs are legal entities organized and operated on behalf of participating dentists for the primary
purpose of collectively entering into contracts to provide prepaid dental services to enrolled
groups. They are organized and operated on behalf of dentists or dental societies as a way to
leverage their ability to compete in the dental benefits market.
IPAs are similar to the capitation-risk pool model except that they pay providers solely from a
risk pool. An IPA may contract directly with a group purchaser or with an insurance carrier for
delivery of dental benefits. Generally, IPA dentists assume financial risk for the program and are
reimbursed directly via the agreement with the purchaser. Participating dentists practice in their
own offices and can also provide care to patients not covered by the IPA contract. Instead of
assigning relative value systems to the procedures performed, each dentist in the association files
claims, noting the usual fees charged for services provided to IPA subscribers. If program costs
exceed premium income, participating dentists may receive less income than the actual value of
the services performed.
Insurance-Free Practices:
A growing number of dentists are distancing themselves and their practices from dental
insurance companies and proudly claiming to be “insurance-free.” This is an interesting and
significant trend inasmuch as most surveys regarding the practice of dentistry point to the fact
that most respondents report their number one problem is dealing with the dental insurance
companies. The concept is being encouraged by consultants who are on the circuit giving
reasons such as bureaucratic problems, excessive paperwork, payment delays, interference with
treatment, fee restrictions, interference with the dentist-patient relationship, being kept “on hold”
for excessive periods of time, inappropriate and unfair insurance company policies, lost forms,
lost x-rays, comments such as “we never received your claim form”, etc. Additionally, patients
also experience frustration in light of greater limitations, restrictions, and exclusions as well as
stagnant annual maximums in the presence of significantly higher dental costs. Most dentists
who take this step refuse to submit claims directly to the insurance company although they will
fill out a standard claim form and give it to the patient. Most will not accept assignment, but
rather make their financial arrangement directly with the patient who is solely responsible for the
finances. This type of practice modality is not for everyone and all aspects of your practice
should be examined before cutting ties with the carriers. Consultations with dentists who have
moved in this direction or with consultants who are experts in this arena are appropriate.
Managed Care:
Managed care is a term for a concept that is continually evolving. Because of the differences
between medicine and dentistry, medical managed care concepts do not always transfer well to
the practice of dentistry. Managed care is a general term designed to affect cost containment. It
often refers to capitation-type payment modalities, but may include modified capitation, HMOs,
PPOs, or other provider discount systems. It may include the concepts of utilization review,
utilization management, record audits, and/or fee limitations.
Management Service Organizations (MSOs):
13
For AGD Constituent Use Only
Management Service Organizations (MSOs) are a more recent entry into the dental health care
delivery system. Under this structure, a third-party corporate entity purchases a dental practice
and hires dentists as employees. The ADA is researching the implications of MSO dental
models and will contact members employed through this system in order to learn more about it,
how it works, and its impact on the doctor/patient relationship, as well as whether it interferes
with the dentist’s use of professional judgment. While the answers are still unknown, many have
expressed concern that these arrangements may focus primarily on financial elements and place
too little emphasis on the practitioner’s professional judgment. Additional issues include the
grievance process and the ability of the state dental board to revoke the license of a dentist who
claimed to have been performing under the direction of an employer.
The MSO model opens the door for non-dental ownership of the practice, which both the ADA
and the AGD oppose.
Preferred Provider Organizations (PPOs):
The preferred provider organization (PPO) benefits model is a contracted plan under which
contracting dentists agree to discount their fees as a financial incentive for patients to select their
particular practices.* These individual dentists, most of whom have been solicited by carriers,
agree to provide treatment to eligible subscribers at fees below those most frequently charged in
the community. This serves as an incentive for patients and, in return, the carrier and sometimes
the purchaser agree to promote the contracting dental facility to plan subscribers. These
arrangements often feature priority claims service for patients being treated by contracting
providers and sometimes include coverage for services not covered in many standard contracts.
This benefits model offers eligible subscribers freedom of choice, but provides financial
incentive—a discounted fee schedule—to encourage subscribers to seek care from a participating
provider. Subscribers may elect to receive treatment from non-contracting providers, but will be
required to contribute a greater co-payment since the insurer will pay these claims at a lower
percentage.
The PPO program allows participating health care providers to remain in traditional fee-forservice practice while still being able to compete for dental benefits dollars. While this benefit
program typically does not require the dentist to assume additional financial risks, the
contracting provider is subject to, and must abide by, utilization review or else leave the plan.
An Exclusive Provider Organization (EPO) is the same as a PPO except there is no freedom of
choice for subscribers. Subscribers must seek care from panel dentists to receive benefits. They
are not eligible for financial benefits if they prefer to choose their own dentist.
Table of Allowances/Fixed Benefit Programs:
The table of allowance program specifies a maximum dollar benefit for each covered procedure,
regardless of the fee charged. As a result, there is sometimes a difference between allowed
coverage and the fee charged. Plans vary according to their provisions to adjust reimbursement
rates for inflation and according to the determination of coverage for required procedures not
included in the table.
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For AGD Constituent Use Only
The table of allowance model sets benefits in specific dollar amounts for all covered procedures.
Benefits are payable only in amounts equal to or less than the fees specified in the table.
Frequently, such plans do not automatically respond to fluctuations in the dentist’s fees and may
result in an increase in the cost to subscribers. Also, since schedules are usually set in relation to
the administrator’s calculation of community fees, subscribers may measure the fees charged
against the benefits in the table and believe that the fees charged are inappropriate. In instances
when allowances are set at levels that are high in relation to community fees, fees at the lower
end typically rise to the level of the schedule, thereby giving less assurance that a reasonable
degree of cost-sharing is maintained and that the determination of allowances for specific
procedures may influence the course of treatment. Table of allowance plans are relatively simple
and easily understood by subscribers.
Usual, Customary, and Reasonable (UCR) Programs:
Usual, Customary, and Reasonable (UCR) programs are dental benefit plans that determine
benefits based on “usual, customary, and reasonable” fee criteria. The reimbursement
percentage depends on the treatment category of care provided. UCR fees may vary greatly due
to wide fluctuations in the demographic data (which may be based on national, regional, ZIP
code or another demographic breakout) used, as well as due to a lack of regulation or consistency
of the determination for the “customary” fee levels.*
Before reviewing the specific aspects of a UCR program, it is important to understand the
definitions of each term. These are outlined below.

A usual fee is the fee that an individual dentist most frequently charges for a specific
dental procedure.

A customary fee is the fee level determined by the administrator of a dental benefits plan
to establish the maximum benefit payable under a given plan for that specific procedure.

A reasonable fee is the fee charged by a dentist for a specific dental procedure that has
been modified by the nature and severity of the condition being treated and by any
medical or dental complications or unusual circumstances and therefore may differ from
the dentist's usual fee or the benefit administrator’s customary fee.
In the UCR dental benefits model, benefits are based on fees charged by the dental provider, but
only to the extent that each fee is no greater than the maximum allowable fee as determined by
the program administrator, based on procedural or composite fee data or other considerations.
Most UCR programs provide a high level of benefits and permit the weighting of benefits to
encourage preventive care while imposing a limit on the fees upon which benefits will be
calculated. Since benefits are primarily based on fees charged, UCR programs often respond
automatically to fluctuations in the cost of dental care. However, compared to other plans, UCRs
can be more expensive for group purchasers to offer and administer and the complex definitions
of UCR may make it difficult for subscribers to understand the benefit levels. Also, the design
of the program may cause some subscribers to have more of a co-payment if their provider’s fees
are determined to be above the UCR for that community.
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III. How to Resolve Conflicts
General
Opening or building a dental practice is a difficult and laborious activity, and the process rarely
becomes easier. As with others starting a business, the dental health care provider is required to
fulfill a variety of roles, with each one having unique interests and priorities. Your
responsibilities as an employer differ from your requirements as a small business owner and
operator, which differ from your responsibilities as an involved citizen within your community,
and so on. You are also a health care professional whose goal is to provide quality treatment to
each patient and to build a successful practice.
As you juggle the various responsibilities inherent in each of these roles, your patients may also
call upon you to serve as the intermediary with their employer or insurance carrier in order to
ensure that they receive the maximum benefits allowed under their dental insurance plans, while
they contribute the lowest rate of co-payment possible. For many practitioners and their
employees, this role produces the most stress and requires the most time. In fact, previous
membership surveys have shown that members want the AGD to be actively involved in solving
problems with third-party payment mechanisms. While there is no “quick fix” approach to
resolving conflicts with third-party carriers, this chapter may help to reduce the frequency of
these situations. On the following pages are descriptions of problems common to third-parties
and sample draft responses to assist you in resolving these situations. You may also want to
refer to Chapter 4, which lists relevant AGD policies and to Chapter 6, which contains additional
information from the AGD’s Membership Survey and fact sheets to assist you in educating
patients and resolving problems with carriers.
AGD Headquarters has often successfully intervened on members’ behalf to resolve a variety of
problems with third-party carriers. Successes include persuading an insurance company to
change its policy and allow dentists to prescribe nicotine patches and persuading a self-funded
plan to change its policy to allow general dentists to perform services that were previously
identified as a specialty area.
The AGD also played a key role in changing the placement of a fraud warning on one carrier’s
Explanation of Benefits statement. A few years ago, the California State Society of
Orthodontists announced a media campaign that would result in consumers bypassing general
dentists as primary oral caregivers. Their consumer kit instructed parents on how to take
impressions to determine whether their children needed orthodontic exams. After speaking with
the AGD, their campaign was altered to encourage consumers to seek services from general
practitioners as well as orthodontists. Most recently, the AGD and other organizations
successfully compelled a clear aligner company to remove its onerous minimum patient quota
requirement for use of its product.
Make sure to keep AGD Headquarters informed of situations with third-parties. They are always
interested in learning about constituent success stories, and can provide guidance and other
assistance.
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For AGD Constituent Use Only
Self-Funded Programs:
Be aware that the conflict resolution approaches suggested in this chapter may not always be
successful, particularly in cases involving self-funded insurance programs. In this dental benefits
model, rather than purchasing coverage from an insurance carrier, the employer or sponsoring
entity assumes the role of insuring agency and incurs the financial risk of the program. Often an
insurance carrier or third-party administrator may be retained to process claims and perform
other administrative functions.
Self-funded plans are regulated by the Employee Retirement and Income Security Act (ERISA)
and are exempt from state regulations. As a result, the individual State Boards of Insurance can’t
act on complaints against either a third-party administrator or the company offering the selffunded plan to its employees. In addition, some insurance companies that offer traditional
insurance also serve as third-party administrators for self-funded plans. This sometimes causes
confusion in determining where to refer a patient for investigation of a complaint. When in
doubt, contact the claim office to determine if the plan is self-funded or if it is a group insurance
policy. When a problem arises under a self-funded plan, the U.S. Department of Labor is the
appropriate authority for investigating the patient’s written complaint.
It is important to be aware that ERISA does not specify time limits for the payment of claims,
but reasonably prompt payment is expected. In those cases where a self-funded program
habitually delays payment for an unreasonable amount of time, you may receive payments more
promptly by sending a letter of complaint to the employer or the third-party administrator.
AGD Checklist for Resolving Problems with Carriers:
Before consulting the suggested steps to resolve any particular situation, we suggest you review
the AGD Checklist for Resolving Problems with Carriers, which appears on the next two pages.
We also encourage you to communicate these guidelines to your membership by printing them in
your constituent newsletter or by distributing them in response to member requests for assistance
in resolving third-party conflicts.
The Checklist was developed by the Dental Practice Council as a way to help individual
members resolve third-party problems. Council members believe that it is best to handle most
situations locally by having the dentist’s office staff work directly with the carrier. The Checklist
calls for the dentist’s office staff to build a cooperative relationship with local carriers. A good
working relationship can solve many problems, and the closer the practitioner and staff are to the
carrier, the more effective they can be at resolving any difficulties.
The Council also suggests involving the patient in the resolution process. The individual patient
is most impacted by the carrier’s policies—he or she needs and wants the dental treatment and is
ultimately responsible for payment. Also, the carrier is more likely to listen to the patient’s
complaint about the policies of the dental plan than to respond to the objections of an outside
party.
17
For AGD Constituent Use Only
AGD CHECKLIST FOR
RESOLVING PROBLEMS WITH CARRIERS
Type of Insurance:
___
HMO
___
PPO
___
Capitation
___
Fee-for-Service (indemnity)
I
Specifically, what is the problem, what is your complaint and what is it that you
would like the AGD to do for you? How would you like to see this case resolved?
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
II
Have you enclosed all pertinent correspondence and information?
III
Have you contacted the carrier in an attempt to resolve this case?
A.
Have you determined whether this is a contractual limitation? If so,
what does the contract state?
1.
Did you speak with a dentist or a clerk?
Name __________________________________________________
Phone (_______) ________________________
Date _________________
a.
2.
IV
Did you record the person’s/persons’ name(s) and telephone
number, the date of your conversation, and the
concerns/decisions discussed?
Is there someone in a position of higher authority that you should talk to?
a.
Did you write to the president and/or chairperson of the
company?
Have you asked the patient to intercede?
A.
Has the patient notified his or her employer, benefits manager, and/or union
representative?
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For AGD Constituent Use Only
B.
V
Is an internal appeal process available?
A.
VI
Do you have copies of that correspondence? (Make and keep copies of all
correspondence)
Has the patient used it?
Have you notified the following organizations in the sequence shown below?
A.
Local dental society
1.
Is peer review a viable option?
B.
State dental society
1.
Do local relationships allow for direct intervention?
C.
State insurance commissioner
1.
Is the carrier operating under a state issued certificate of insurance?*
2.
Is it a self-funded plan regulated by ERISA?*
D.
American Dental Association’s Council on Dental Benefits
E.
Academy of General Dentistry’s Dental Practice Council
1.
Do you agree to inform the AGD of any change in the
disposition of this case, such as a resolution or withdrawal?
2.
VII
Do you agree to inform the AGD of any further communication
on the part of the carrier, the patient, or yourself?
Have you and/or your patient sought legal advice?
A.
Have you and/or your patient discussed the possibility of resolving the matter
through the courts?
*NOTE: A Certificate of Insurance is regulated by the State Insurance Commissioner and
the State’s insurance laws. The patient may contact the department of insurance
regulation or whatever regulatory agency exists for these purposes.
19
For AGD Constituent Use Only
Self-Funded Plans are regulated by ERISA (the Federal Employment Retirement
Income Security Act). Plan participants have a right to examine all insurance
documents in the plan administrator’s office at no charge. Copies of documents
can be obtained for which there may be a reasonable charge. If the claim for
benefits is denied in whole or part, the plan administrator must provide a written
explanation of the reason for the denial. The patient has the right to have the
claim reviewed and reconsidered. There are steps that can be taken to enforce
those rights. These include filing suit in a federal court or seeking assistance from
the nearest area office of the U.S. Labor-Management Services, Department of
Labor. Some concerns, such as coordination of benefits, may be appropriately
communicated to the state insurance commissioner.
AGD Dental Practice Council
October 21 and 22, 2005
Complaint Reporting Form:
The AGD has adapted the Complaint Resolution Form used by the ADA in its third-party
problem resolution program in order to assist constituent dental care chairpersons in reporting
local problems to the national organization. Upon being notified by a member that he or she is
experiencing difficulty in satisfactorily resolving a complaint with a third-party carrier, you
should first make certain that the individual has followed the AGD Checklist for Resolving
Problems with Carriers and then determine what support you, as the Constituent Dental
Care/Practice Chair, can provide. Once you determine that all possible avenues have been
explored, you should copy and complete the following Complaint Reporting Forms and submit
it, and all relevant background information, to AGD Headquarters. Staff will then review the
situation and determine what future action is appropriate. You should also notify your state
dental association about the problem.
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For AGD Constituent Use Only
AGD COMPLAINT REPORTING FORM
Information Only; No Action Required: Yes ___ No___
Desire Assistance: Yes ___ No___
PROVIDER INFORMATION:
Last Name
First Name
AGD Member #
Region/State
Office Phone (
)
___
M.I. ____
Home Phone (_______)_______________________
INSURED INFORMATION (SUBSCRIBER):
Last Name
First Name
___
M.I. ____
Address _____________________________________________________________________________
City
___
State
Date of Original Claim:
__
ZIP
Phone (_______)__________________
__
Social Security # __________________________
PATIENT (IF DIFFERENT FROM SUBSCRIBER):
Last Name
First Name
Relationship to Subscriber: Self (1)
City
State
Spouse (2)
ZIP
M.I. _____
Child (3)
Other (4) ____
Phone (_______)_________________
Please submit, with this form, an authorization for release of patient information
that complies with the Health Insurance Portability and Accountability Act of 1996
(HIPAA) and is signed by the patient or an authorized representative, prior to the
release of any information related to the patient or this claim, including, but not
limited to charts, x-rays and other records of treatment, to the Academy of
General Dentistry. Patient information that is not accompanied by a HIPAA
compliant authorization for release of information, signed by the patient or an
authorized representative, shall not be accepted or considered.
21
For AGD Constituent Use Only
EMPLOYER INFORMATION (Please complete the following information if it is known):
Name: ____________________________________________________________________________
Address ___________________________________________________________________________
City ________________________ State
ZIP
Benefits Contact: ___________________________________
Phone (_______)_________________
Phone (_______)_________________
THIRD PARTY INFORMATION:
Policy # _____________________________________
Name of Insurance Company: __________________________________________________________
Address _____________________________________________________________________________
City _______________________ State
Contact Person:
Zip
Phone (______)__________________
Phone (______)___________________ Plan Type _____
NATURE OF COMPLAINT—CHECK ALL THAT APPLY:
Lost/Misplaced Claim (LMC)
Dentist Consultant Review (DCR)
Lost/Misplaced Radiographs (LMR)
Unqualified Claim Reviewer (UNR)
Unauthorized ADA Code Change (UCC)
Coordination of Benefits (COB)
UCR Fee Dispute (UCR)
Explanation of Benefits (EOB)
Delay/Lack of Response (DLR)
Treatment of Relative (TOR)
Assignment of Benefits (AOB)
Denial of Claim (DEC)
Other (OTH): __________________________________________
NATURE OF THE PROBLEM:
In your own words, describe the details of the problem. If more space is needed, attach additional sheets.
Include all supporting documents: letters, claims forms, explanation of benefits (EOBs), remittance
advice, etc.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
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For AGD Constituent Use Only
EFFORTS TO RESOLVE THE PROBLEM (Describe what you have done to resolve this conflict):
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Forward to:
The Academy of General Dentistry
Director, Dental Practice Advocacy
211 East Chicago Avenue, Suite 900
Chicago, IL 60611-1999
------------------------------------------------------------------------------------------------------------------------------Date
Entered
Complaint
Deposition
Date
Resolved
23
Region/State _________
For AGD Constituent Use Only
Pre-Approach:
As your Constituent’s Dental Care/Practice Chair, you must communicate effectively with thirdparty carriers. When assisting members, it is always best to have a copy of all documents related
to the situation before initiating any activity. The following pre-approach letter, designed by the
Dental Practice Council, requests the carrier to explain the specific cause for the benefit
denial/reduction. This letter may assist you in gathering pertinent facts and allow you to
objectively analyze the situation. If you are already aware of the specific reason for the
denial/reduction, you need not use this letter but rather may move onto another, more appropriate
text.
Draft of a Pre-Approach Letter
Date
Name of Carrier Executive
Title
Name of Carrier
Complete Street Address
City, State, ZIP
Dear (Insert Name):
A member of our organization, Dr. (Name), has shared with us your (denial/reduction) of benefits for
his/her patient M/M (Name). We are writing to you on behalf of Dr. (Name) to request the specific
reason for this decision.
In order for us to gain some valuable information, which might assist us in resolving this problem for our
member, we would appreciate a response from you as soon as possible, hopefully by (date).
Sincerely,
Your Name
Constituent Dental Care/Practice Chair
Academy of General Dentistry
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For AGD Constituent Use Only
Benefit Exclusion Clauses:
AGD membership surveys have indicated that 70.2 percent of responding general dentists
reported that they have been denied payment of benefits for providing certain services. When a
member of your constituent advises you that a carrier’s policy includes benefits exclusion
clauses, your best approach may be to direct a polite and informative letter to the carrier pointing
out the policy’s shortcoming. Be certain to send copies of the letter to the member, to the
Director, Dental Practice Advocacy, at the AGD, and the individual at the state dental
association who is responsible for dental care issues. A sample letter follows.
Draft Response to Benefit Exclusion Clauses
Date
Name of Carrier Executive, Title
Name of Carrier
Complete Street Address
City, State, Z
Dear (Insert Name):
One of our members, Dr. (insert name), has expressed concern that (insert carrier’s name) dental
insurance policy as held by (insert employer’s name) will reimburse plan participants for (specify type of
treatment, such as endodontic, orthodontic, periodontic, etc.) dental treatment only when it is rendered by
a (insert type of specialist, such as endodontist, orthodontist, etc.). We are attaching copies of the
correspondence our member has provided us, which includes notification that (insert carrier’s name) will
not pay for this treatment unless it has been performed by a specialist. It would seem to us that the patient
is being penalized for going to a general dentist who felt sufficiently qualified to deliver this therapy
without having to refer the case to a specialist.
Select text as applicable to the situation.
There are many areas of the country that have few, if any, dental specialists. According to a recent survey
of Academy of General Dentistry (AGD) members, nearly (insert appropriate figure from the chart that
appears at the end of this chapter) percent of responding general dentists perform this type of treatment.
By limiting the availability of these services, the price of this treatment may greatly increase as fewer
dentists are available to render these services, or some individuals requiring treatment will find it
extremely difficult to locate dentists to perform the necessary procedures.
It is the nature of the state regulatory agencies to license general dentists to perform all phases of dentistry
and to give them the discretion to determine when a case should be referred to a specialist. Referral
should be at the discretion of the treating dentist.
As an organization of 35,000 general dentists which fosters continuing education for general dentists, the
AGD encourages its members to continually update their knowledge so they can effectively deliver
patient treatment. We urge you to change this discriminatory policy which has the potential to create so
much dissatisfaction for the subscribers to this dental benefits plan. We look forward to hearing from you
soon.
Sincerely,
Your Name
Constituent Dental Care/Practice Chair
Academy of General Dentistry
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For AGD Constituent Use Only
Limitation of Benefit Based on UCR:
When patients claim that they have been overcharged because your fee for providing treatment
exceeds the amount covered by their dental plan, the best response is usually to advance patient
education. Make certain that the form your practice uses to record patients’ medical histories
clearly states that any difference between the fee charged and the benefit paid is due to
limitations in the individual’s employer’s benefit contract, and that any unpaid funds are the
patient’s responsibility.
When a patient notifies you that his or her benefit is lower than your fee for service, explain in
writing that the treatment plan developed and followed was based on what was in the
individual’s best interest for maximum improved or maintained oral health care, not on the basis
of what services or fees were approved under the patient’s dental insurance program, which
frequently provide less than optimal benefits. Inform your patient that fees are based on practice
overhead, the treatment plan selected and the time involved in providing appropriate dental care.
Note that it is in no one’s best interest to compromise recommended treatment solely to
accommodate a third party’s maximum benefit allowance, which may barely be adequate, much
less optimal. Indicate that you are willing to review the treatment plan and the rationale for your
professional judgment regarding this case and how it might differ from the third-party carrier’s
position. Let your patient know that you base your treatment decisions upon your professional
judgment, regardless of whether the individual is covered by an insurance plan. The insurance
carrier may be basing its fees on out-of-date information or it may not have taken into account
certain local factors that may affect the fees for various services.
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For AGD Constituent Use Only
Draft Response to Limitation of Benefit Based on UCR
Date
Patient Name
Complete Street Address
City, State, ZIP
Dear (Insert Name):
You recently contacted my office to let us know that your dental insurance benefit program provides
coverage for (specify type of treatment) at a rate lower than the fee you have been charged. I would like
to take this opportunity to explain to you why my fee for this service differs from what your carrier may
have called the “usual, customary and reasonable” fee.
My professional philosophy is to develop and follow treatment plans that are based on what was in your
best interest for maximum improved or maintained oral health care. My treatment decisions are not based
on what services or fees are approved under your dental insurance program. In fact, it is not uncommon
for dental insurance plans to provide their subscribers with less than optimal benefits. My fees are based
on three elements—the cost of overhead to operate my practice, the cost of delivering the treatment that
you and I have selected, and the cost of the time involved in providing you with this care.
You do not benefit if the recommended treatment is compromised for the sole purpose of accommodating
a third party’s maximum benefit allowance.
If your dental insurance carrier has a qualified dentist on staff who reviews claims, I would be happy to
discuss your case with this individual. I would hope that after reviewing the treatment plan and specifics
of your case, the dental consultant would be better informed to take a stand regarding this case.
You should be aware that insurance carriers frequently base their determinations of “usual, customary and
reasonable” fees on out-of-date information or they may not take into account certain local factors that
affect the fees for various services. In any case, you may be assured that for all of my patients, I base my
treatment decisions upon my best professional judgment, not upon the patient’s third-party carrier’s dental
benefits plan.
Please contact me with the name and telephone number of your carrier’s dental consultant in the event
that you would like me to review the specifics of your case with that individual.
Sincerely yours,
Your Name
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When a Carrier Changes the Original Treatment Code:
AGD membership surveys have indicated that 75 percent of our members perform non-surgical
periodontics. Many carriers have become increasingly concerned about the expense of honoring
claims for periodontal care, while practitioners remain concerned with the ability to properly
provide the care their patients require. In recent years, carriers have begun to seek more specific
information from dentists regarding periodontal therapy. They question methods of treatment
and sometimes change treatment codes in order to pay benefits at a lower level. In fact, some
dentists provide therapeutic periodontal procedures and are paid at prophylaxis fees.
Codes for periodontal disease vary according to the level of disease a patient may have and the
provider’s method of treatment. Providers need to be certain that they understand the proper use
of each code to ensure that patients receive their entitled benefits and the necessary and
appropriate treatment. One way to lessen the possibility of claims being questioned and codes
being changed is to complete the narrative portion on the patient’s claim.
When a member advises you that a carrier has denied a patient’s benefit by changing the
treatment code, advise him or her to direct a polite and informative letter explaining how the
diagnosis was reached and how the patient’s treatment relates to the code’s definition.
It may also be helpful to provide the carrier with copies of the patient’s chart, X-rays, and
drawings to support the provider’s diagnosis and treatment.
Both the AGD and the ADA recommend reporting all instances of downgrading of codes by
carriers to the state insurance commissioner and to the patient’s employer.
Draft Response to a Carrier Changing the Original Treatment Code
Date
Name of Carrier Executive
Title
Name of Carrier
Complete Street Address
City, State, ZIP
Dear (Insert Name):
One of our members has expressed concern because (insert carrier’s name) has denied a patient proper
reimbursement by changing the code for periodontal disease treatment.
The Academy of General Dentistry, an organization of approximately 35,000 general practitioners, fosters
continuing education for general dentists and encourages them to continually update their knowledge so
that they can be more effective in rendering patient treatment.
(Insert a paragraph about the code’s definition and how it specifically relates to the patient’s diagnosis
and treatment.)
While we are sensitive to your desire to control health care expenditures, we believe that by changing
codes, you are misleading the patient and second-guessing the doctor’s diagnosis. I urge you to review
28
For AGD Constituent Use Only
this estimate and revise it to cover the appropriately prescribed and delivered periodontal disease
treatment.
Sincerely,
Your Name
Constituent Dental Care/Practice Chair
Academy of General Dentistry
Denial of Benefits When Treating Family Members:
Many insurance companies have policies against reimbursing subscribers for treatment costs
when care is rendered by a family member, claiming that health care professionals do not bill
their spouses, parents, siblings or children. While this is not always the case, and while the
patient should be allowed the freedom of choice to select a dental health care provider regardless
of a familial relationship, the fact remains that the contractual provisions of many third-party
plans disallow payment of benefits when there is a familial relationship between the provider and
patient.
AGD membership surveys have indicated that 21.1 percent of dentists have reported denial of
benefits when treating a family member. While plan subscribers pay premiums for the dental
benefits, their freedom of choice is often limited by the exclusion of situations when care is
provided by a member of the family. There is little chance that an appeal of this policy will be
successful if this exclusion is stated in the plan’s contract or provisions. An appeal may be
successful if a benefits policy is changed and the insurer or carrier fails to notify subscribers.
Denial of Payment for Covered Procedures per the Contract Language:
Nearly every dentist whose patients have dental insurance has experienced the situation when a
third-party insurer denies payment for a procedure that the provider felt should have been
covered under the language of the contract. An AGD membership survey indicated that 70.2
percent of all respondents experienced this problem. If this should happen to you, bear in mind
that insurance companies typically don’t deny payment arbitrarily—if you’re willing to
investigate the case, chances are you’ll discover the reason for the differences of opinion.
No one is immune from human error, be they your employees or the employees of an insurance
company. When a claim is rejected, the first thing you should do is review the information
available to you. Review the limitations of the contract. Make certain that you submitted the
correct procedure code number. Determine whether the patient has run out of dental benefits for
the year. Verify that your office followed the instructions established by the insurance carrier,
such as making certain that written explanations were provided for those procedures requiring a
narrative account.
Once you determine that correct submission procedures were followed and that the patient was
not at the limit of his or her benefits, call the carrier to determine why the claim was denied.
Discuss the case with someone other than the claims processor, preferably the dental consultant
or someone from the provider relations department. Offer the facts about why you believe the
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treatment provided was covered under the benefits contract. Follow the steps outlined in the
AGD Checklist for Resolving Problems with Carriers.
Your chances of affecting change likely depend upon the responsiveness of the carrier. Keep in
mind that pre-determination of benefits could help minimize this problem.
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Professional Courtesy:
Unfortunately, cases involving one dentist making disparaging remarks about another dental
professional occur all too frequently. These situations are probably among the most frustrating
since they indicate a lack of professional courtesy and behavior from other practicing dentists
and may serve as evidence in a malpractice lawsuit. In any case, the most effective approach
calls for you to be professional, practical, and correct in your expectations, as well as courteous
in your approach. You may be able to successfully resolve this type of incident by following
these key steps:

Contact the individual who made the remark directly. Establish dialogue and suggest talking
about it over lunch.

Contact your local or state dental association to have this adjudicated through an ethics
committee, since speaking disparagingly of colleagues could be considered a breach of
ethics.

Seek legal redress through an attorney. This will create bad feelings, but it can be effective
in ending the problem.
In addition, the ADA’s Principles document states in Advisory Opinion 4-C that dentists are
under obligation to report to “appropriate reviewing” agencies any “gross or continual faulty
treatment by other dentists.” This does not mean a dentist may harshly criticize a colleague to
the public nor does it allow a practitioner to suggest that a non-specialist also providing general
specialty services is unqualified to do so.
Loss of Radiographs:
An AGD membership survey indicated that 52.2 percent of respondents reported loss of
radiographs as one of the problems they encounter with third-party carriers. There is little an
individual practitioner can do to prevent a third-party carrier from misplacing the radiographs of
subscribing patients. As a result, the most effective precaution you can take is to always send
duplicate copies and maintain the originals of all radiographs in your own files. Some
practitioners take what is known as “double pack” radiographs in order to ensure that they have a
second copy. Others take two pictures or have a duplicating machine in the office to make
certain that they’re able to satisfy the needs of the third-party carrier and maintain the integrity of
their own files. This is especially important because in the event of a lawsuit, radiographs would
be important part of the provider’s defense.
Of course, doubling up on radiographs as a preventive measure involves additional expense.
Since it’s impossible to predict which patients’ dental insurance plans will require radiographs,
it’s next to impossible to know which patients should undergo “double pack” radiographs. Many
practitioners are not comfortable going through the efforts and cost of duplicating all radiographs
or find it difficult to charge patients for the fees associated with meeting the requirements of their
dental benefits plans. Yet few third-party carriers have policies that reimburse providers for the
cost of supplying duplicates of radiographs, and although it should not be the case, the provider
most frequently bears the cost of duplicating radiographs. However, many practitioners prefer
this option to risking the loss of original radiographs by submitting them to third-party carriers.
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With the onset of digital technology, duplicates may become less of an issue. Digital
radiography is a contemporary modality with increasing use that will likely enable you to send
copies of X-rays while maintaining the original.
Misdirected Payment of Benefits:
In situations when payment was issued directly to the patient despite the assignment of benefits,
most third-party payers will acknowledge and correct the mistake, although in some states they
may not be obligated to do so. In cases when the benefit check is issued to the patient by
mistake, contact the patient, indicate the situation and request that payment be remitted to your
practice. If the patent refuses to cooperate, turn the account over for collection and notify the
patient’s employer.
If a particular carrier consistently takes an excessive amount of time to process claims or often
loses them, you may wish to send future claims by certified mail. However, you should
remember that unless a written agreement exists to the contrary, the third-party carrier’s
responsibility is to the patient, not the provider.
Periods of Patient Ineligibility:
Many dental insurance benefit programs delay patient eligibility for coverage for a certain time
period initially after enrollment. Other programs allow only basic services for a given time
frame, and require a longer period of participation in the plan before covering other services,
such as periodontal care. Other plans have been known to require patients to complete an
“evidence of insurability” form, which the carrier deems is a necessary and sound business
practice that prevents patients from engaging in “adverse” selection, or in the selection of dental
coverage only during the time period that they expect to need extensive treatment. Third-party
carriers use each of these mechanisms to control or contain the costs of providing care to their
subscribers.
There is little the provider can do to counter the carrier’s restrictions on subscriber eligibility.
Pre-determination:
The acts of submitting a treatment plan for pre-determination or of pre-certifying a patient’s
eligibility do not guarantee payment of benefit. It’s critical that the health care provider have a
thorough understanding of the nuances, and commitments, associated with each of these terms.
The ADA’s official definitions of each term are outlined below; however, it should be noted that
their use by third parties is not consistent.

Pre-certification: Confirmation by a third-party payer of a patient’s eligibility for coverage
under a dental benefits program.

Pre-determination: An administrative procedure that may require the dentist to submit a
treatment plan to the third party before treatment is begun. The third party usually returns
the treatment plan indicating one or more of the following: patient’s eligibility, guarantee of
eligibility period, covered services, benefit amounts payable, application of appropriate
deductibles, co-payment, and/or maximum limitation.
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Reduced Benefits for Non-contracting Providers:
Nearly 64 percent of the respondents to an AGD membership survey reported diminished
payment of benefit because they were not a participating provider; this problem has shown a
great increase in frequency over the past two years.
While more providers are participating in a wider variety of dental benefits plans, at some time
every practitioner experiences the situation where payment of benefits are reduced because you
are a non-contracting provider. In these instances you must contact the patient who is
responsible for paying any balance due. Upon welcoming a patient into your practice, you
should consider asking the patient to read and sign a statement agreeing to assume financial
responsibility for any treatment, regardless of the amount of benefit paid by a third-party carrier.
Two-Tiered Reimbursement Systems:
The AGD opposes separate fee levels to specialists providing the same or similar services as
general practitioners. When a general dentist performs a procedure that he or she is licensed to
do, reimbursement should be the same as that provided to a specialist. Two-tiered
reimbursement practices reaffirm a caste system within the profession, implying that specialists
are worth more simply because they’re specialists.
Yet patients also suffer under two-tiered reimbursement systems. If a patient is reimbursed at a
lower rate when being treated by a general dentist instead of a specialist, the carrier is suggesting
that the subscriber should receive care from a specialist, even though treatment by the general
practitioner may be more reasonably priced. If the subscriber is not aware that the
reimbursement will be less if care is rendered by a general practitioner, then the individual
receiving care is penalized because although the patient is paying a set premium regardless of
who delivers care, the reimbursement level for care rendered by the general dentist will be lower
than that given for specialist care.
Unfortunately, two-tiered reimbursement systems are a problem common among general
dentists. Over 52 percent of the respondents to an AGD membership survey reported diminished
payment of benefits because they were general dentists, not specialists.
Changing these types of practices requires a great deal of carefully coordinated communication,
but often the outcome is worth the effort. For instance, the AGD recently was successful in
convincing a dental insurance plan in the northeast to change a two-tiered endodontic
reimbursement practice. Upon being advised by a member that a carrier is engaged in a twotiered reimbursement system, your best approach may be to contact the carrier and detail the
detriment of such a practice. Be certain to send copies of the letter to the member advising you
of the situation, the Chairperson of the Academy’s Dental Practice Council, the AGD Director of
Dental Benefit Programs and Dental Practice, and the individual at the state dental association
who is responsible for dental care issues. A sample letter follows.
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Draft Response to Two-Tiered Reimbursement Practices
Date
Name of Carrier Executive
Title
Name of Carrier
Complete Street Address
City, State, ZIP
Dear (Insert Name):
One of our members has expressed concern regarding a recent practice by (insert carrier’s name) of a
(specify type of treatment, such as endodontic, orthodontic, periodontic, etc.) reimbursement program that
pays (insert type of specialist, such as endodontist, orthodontist, etc.) more than general dentists for
rendering identical services.
The Academy of General Dentistry strongly believes that fees should be determined by the complexity of
the procedure, not by whether a practitioner specializes in a particular area of dentistry.
I am certain that you are aware that there is a hierarchy of dental services associated with any specialty
area. General dentists often perform services at the lower end of the hierarchy and refer the more
complex cases to specialists. Generally, the fees of a general dentist also tend to be at the lower end of
the hierarchy. If the general dentist is qualified to deliver the same treatment as a specialist, it is in
neither your best interest nor the patient’s best interest to reimburse the specialist at a rate higher than the
general dentist.
You should be aware that your policy is also detrimental to your plan’s subscribers, who may not be
aware that the reimbursement will be less if care is rendered by a general practitioner. The subscriber to
your plan pays a set premium regardless of who delivers care. It is unfair to penalize the subscriber for
electing to receive care by a general dentist. In addition, by advocating that patients receive care from
specialists in order to maximize their benefits under your program, you are suggesting that the subscriber
receive care from a specialist, who is almost certain to charge more than a general dentist for providing
the same treatment. As a result, you are ultimately increasing the sum of the reimbursements payable to
participants in your plan. I feel confident in presuming this was not your intent.
We ask that you review this two-tiered reimbursement program and the inequities it creates for all parties
involved.
Sincerely,
Your Name
Constituent Dental Care Chair
Academy of General Dentistry
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Unreturned Referrals:
These situations rate among the most frustrating experiences, since they indicate a lack of respect
for another professional’s practice. Most dentists typically refer patients in need of more
specialized care to other providers with whom they’ve established a professional rapport.
Referring relationships are established on the basis of respect for another provider’s skill and
reputation. For such a relationship to remain strong, both providers rely upon continued
goodwill and follow-up communication as necessary.
Few dentists receiving referred patients for more specialized care would neglect to contact the
referring practitioner to discuss the outcome of a case as this could have a negative impact on
future referrals. However, if you have referred a patient to another dentist and have not received
a follow-up report, contact the dentist by telephone and inquire into the specifics of the case,
such as what treatments were performed and whether there were any problems or if the patient
experienced any pain. It’s likely that your colleague had planned to contact you regarding this
case, but that time had elapsed faster than expected.
If you are frequently required to make follow-up phone calls to a specific practitioner, or if it is
routinely a negative experience, you may wish to discontinue referring patients to that provider.
Utilization Reviews:
Utilization review is a procedure usually undertaken by a third party or an entity that has been
created expressly for this purpose. The goal of utilization review is to determine how often
individual dentists are performing certain procedures and then compare the frequency of these
procedures with other dentists who have also had this determination done. Usually the review,
done with the aid of computers utilizing submitted dental insurance forms, will determine for
example how many crowns are done per 100 patients, or how many scaling and root planings are
done per 100 patients. These ratios are then averaged and the dentists are compared to each
other. Carriers may arbitrarily determine a cut-off point beyond which any dentists whose ratios
for specific procedures fall beyond this are deemed “outliers.” In other words, the carrier has
determined that they perform these particular procedures far in excess than do their fellow
dentists. In some instances, the carriers will contact the dentist and discuss with him or her the
reasons why they may be doing certain procedures to a much greater degree than their
colleagues.
Subsequent to this, the dentists may be “encouraged” to bring the number of these procedures
performed into line with what the carrier has deemed acceptable. If the dentist is a contract
dentist and has not complied with the wishes of the carrier with regard to cutting back on the
number these specific procedures performed, he or she may be asked to leave the network. If the
dentist is not in the network, prior authorization may become a requirement. Still other carriers
may insist on a review of the patient records and if appropriate and adequate (as determined by
the carrier) substantiation for the performance of these procedures is not found in the records, the
carrier may determine that much of the treatment rendered was unnecessary and may ask for
financial reimbursement. Often, unwittingly, dentists agree to abide by these rules and to allow
the carriers to enforce arbitrary regulations regarding utilization review by signing a contract
without carefully examining it or understanding it. It is important, as with any contract, that you
carefully review and evaluate the conditions and rules of a contract prior to signing the contract.
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If you have questions regarding any contract, you may contact the ADA contract analysis service
or the AGD’s Director of Dental Benefit Programs and Dental Practice.
If you are contacted by a member who is notified by a third-party carrier who claims that the
practitioner performs a specific procedure with much greater frequency than other local
practitioners, your best response is to contact the carrier, communicating the ADA’s position that
practitioners ignore these letters. However, it is important to send copies of the letter to the
member advising you of the situation, the chair of the AGD’s Dental Practice Council, the AGD
Director, Dental Benefit Programs and Dental Practice, and the individual at the state dental
association who is responsible for dental care issues so the main offices of the AGD and the
ADA can coordinate their responses. A sample letter follows.
Draft Response to Utilization Reviews
Date
Name of Carrier Executive
Title
Name of Carrier
Complete Street Address
City, State, ZIP
Dear (Insert Name):
One of our members has advised us that they have received utilization review correspondence from you
which indicates that (he/she) performs (specify type of treatment, such as endodontic, orthodontic,
periodontic etc.) treatment with a greater frequency than do other practitioners in the (insert city name)
area.
You are no doubt aware that the Academy of General Dentistry and the American Dental Association
agree that statistically based utilization reviews should in no way be used to determine acceptable norms
of clinical standards of dental practice since these letters present little more than an incomplete and broadbased sketch of the full picture which must be examined in order to determine treatment. In addition,
both organizations remain firm in their positions that dentists receiving such letters should not alter their
practice patterns.
We urge (insert name of carrier) to reconsider the impact of these utilization review letters, which remain
an irritant to practicing dentists.
Sincerely,
Your Name
Constituent Dental Care Chair
Academy of General Dentistry
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Draft Response to Misinterpretation of Coordination of Benefits
Date
Name of Carrier Executive
Title
Name of Carrier
Complete Street Address
City, State, ZIP
Dear (Insert Name):
One of our members, Dr. (name), has expressed concern over a situation involving a patient with two
dental insurance policies. This patient, (insert name), has primary dental insurance through (his/her)
employer, (name), and secondary coverage through (name). Pre-estimations were sent to both carriers in
order to determine the level of benefits that could be expected for treatment costing $(amount). The
patient’s primary carrier estimated payment of benefit at $(amount), and the secondary carrier
communicated to the patient a predetermination of benefits in the amount of $(amount).
When treatment was completed and billing was done, the primary carrier paid $(amount), as stated in
their predetermination of benefit. Your company, however, limited its payment of benefit to $(amount),
downgrading benefits and claiming there was a duplication of benefits. It appears that there is some
misunderstanding regarding the different meanings of duplication of benefits and coordination of benefits.
In fairness to the patient, you may want to establish a coordination of benefits when patients have two
dental benefit plans. This policy could note that in these cases, coverage under both plans should be
coordinated so the patient receives the maximum allowable benefit from each one. The aggregate benefit
should be more than that offered by either plan alone, but not such that the patient receives more than the
total charges for the dental services received.
Accordingly, (insert patient name) should be entitled to receive reimbursement based upon your preestimate, which was developed with full knowledge of the amount that would be paid by the primary
carrier. I urge you to reconsider this case and to rightfully base your payment of benefit on your
predetermination of benefits. Such an action would be consistent with the acceptable positions governing
coordination, not duplication, of benefits.
Dr. (name)’s concern will be communicated to our Dental Practice Council for discussion at its next
meeting. I would appreciate hearing from you as soon as possible so I may share your response with its
members. Thank you.
Sincerely,
Your Name
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Draft Response to Denial of Benefit for Sealants
Date
Name of Carrier Executive
Title
Name of Carrier
Complete Street Address
City, State, ZIP
Dear (Insert Name):
One of our members, Dr. (insert name), has expressed concern that your fund’s insurance program will
not reimburse plan subscribers for the application of pit and fissure sealants. It is your position that
participants who take advantage of (customize text as appropriate, i.e. “two dental exams and cleanings
per year with fluoride treatments for children”) provide adequate protection as long as the patient
regularly practices proper oral hygiene. Your denial of benefits implies that the use of fluoride negates
the need for sealants, which may wear off and require resealing.
It would appear that the designer of your dental plan may not have the latest information on the cost
effectiveness of sealants. You should know that sealants were first developed through dental research in
the 1950s and became commercially available in the early 1970s. They can be highly effective in
protecting treated tooth surfaces from caries and are a very reasonably priced component of preventative
oral health care. In addition to preventing new caries from forming, sealants can stop existing cavities
from further progression because they prevent nutrients from reaching the cavity. While both fluoride
and sealants offer protection against caries, their benefits are complimentary and the application of one
does not preclude the value of the other. In addition, the U.S. Surgeon General’s Report on Oral Health
has identified sealants as a key component in reducing caries among pediatric populations.
Sealants benefit everybody. I urge you to review your benefits program and to revise it to allow payment
of benefit for the application of sealants. Surely the outcome, the improved health of your employees and
lower long-term benefit payouts, is advantageous to everyone involved.
Dr. (insert name)’s concern will be communicated to the Dental Practice Council of the Academy of
General Dentistry, and will be placed on the agenda for their next meeting. I would appreciate hearing
from you as soon as possible so I may share your response with its members. Thank you.
Sincerely,
Your Name
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Draft Response to Rejection of Claim for Overpayment
Date
Name
Address
City, State, ZIP
Dear Name:
Dr. _______, a member of our association, has forwarded a copy of your ______ (date) correspondence to
us. __________ is seeking a refund from Dr. ______ to recover an alleged “overpayment” in the amount
of $_______, which ___________ claims was made by mistake. On behalf of Dr. ________, the
Academy of General Dentistry’s 35,000 members respectfully reject your position.
It is widely held that an insurance carrier is not entitled to recover an overpayment made to an innocent
third-party creditor when: a.) the payment was made due solely to the insurer’s mistake, b.) the mistake
was not induced by a misrepresentation of the third-party creditor, and c.) the third-party creditor acted in
good faith without prior knowledge of the mistake. See Prudential Ins. Co. of America v. Couch, 376
S.E. 2d 104 (W.Va Sup. Ct. of App. 1988); Time Ins. V. Fulton-DeKalb Hosp. Auth., 211 Ga. App. 34,
438 S.E. 2d 149 (Ga. App. 1993); City of Hope Med. Ctr. V. Superior Court, 8 Cal. App. 633, 10 Cal.
Rptr. 2nd 465 (Cal. App. 2 Dist. 1992); Lincoln Nat. Life Ins. V. Brown Schools, 757 S.W. 2d 411 (Tex.
App. 1988); Federated Mutual Ins. Co. v. Good Samaritan Hospital, 191 Neb. 212, 214 N.W. 2d 493
(Neb. Sup. Ct. 1974).
Here, regardless of whether amounts paid by _________ constitute an overpayment, ________ knew its
own policy payment provisions and alone made the decision of paying said amounts that it now alleges
were beyond its responsibility. Dr. ________ made no misrepresentations, had no knowledge or notice of
______’s alleged mistake, extended valuable services, was not unjustly enriched, and simply had no
reason to suspect that the payments for services rendered were in error. _______ was the entity that
treated the situation and was in the best position to have avoided it. Furthermore, Dr. _______ has no
recourse relative to the patient.
Under the circumstances, Dr. _________ has no obligation to return the alleged “overpayment” and
declines to do so. Please confirm that no further efforts will be made to recover said alleged
“overpayment” from Dr. ________. I look forward to hearing your reconsideration.
Sincerely,
Your Name
Chair, Constituent, etc.
cc:
Dr. (Name)
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Draft Response to Denial of Benefit for Dentist Writing a Tobacco Cessation Prescription
Date
Name of Carrier Executive, Title
Name of Carrier
Complete Street Address
City, State, Zip
Dear (Insert Name):
The Academy of General Dentistry, an organization of 35,000 general practitioners, fosters continuing
education for general dentists and encourages them to continually update their knowledge so that they can
be more effective in rendering patient treatment.
One of our members, Dr. (insert name), has expressed concern that your fund’s insurance program will
not reimburse plan subscribers for tobacco cessation prescriptions written by dentists. According to a
patient, reimbursement for this type of health improvement care is only available in cases when the
prescription is written by a medical doctor. This unnecessarily restrictive policy may actually be causing
your firm to pay higher benefits in the long term, as several recent studies have proven that employees
who continue to use tobacco products are more susceptible to illness and absence, and they frequently
must be treated for very serious, even life-threatening, diseases.
The number of dentists writing prescriptions for such products is on the rise. In fact, many pharmaceutical
firms are promoting the dentist’s role in tobacco cessation support through programs geared to the
profession, to pharmacists and to the general public. The U.S. Department of Health and Human Services
(Canadian Ministry of Health) is directly involved with the major dental organizations in having the
dental profession more involved in tobacco cessation programs because a large percentage of the public is
likely to visit the dental office at least once each year.
The American Cancer Society estimates that each year, there are more than 30,000 new cases of oral
cancer and more than 8,000 deaths caused by oral cancer. About 75 percent of these cancers can be
attributed to smoking and/or alcohol use. Early diagnosis is often possible with oral cancers, and by
supporting the tobacco cessation efforts of your employees; you can reduce their risks of becoming one of
these statistics. In addition, you greatly reduce insurance claims submitted in response to diseases
brought on by tobacco use.
I urge you to review your benefits program and to revise it to allow equal benefit for tobacco cessation
treatment, regardless of whether the prescribing practitioner is a physician or dentist. Surely the outcome,
the improved health of your employees and lower long-term benefit payouts, is advantageous to everyone
involved. A copy of this letter is being directed to the attention of (insert name), an administrator of your
account, so the two of you can review and update your policy.
Dr. (insert name)’s concern will be communicated to the Dental Practice Council of the Academy of
General Dentistry, and will be placed on the agenda for their next meeting. I would appreciate hearing
from you as soon as possible so I may share your response with its members. Thank you.
Sincerely,
Your Name
Constituent Dental Care Chair
Academy of General Dentistry
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AGD Checklist for Resolving Problems with Dental Products and Material and the
AGD Checklist for Resolving Problems with Dental Equipment
Before consulting the suggested steps to resolve any particular situation, we suggest you review
the AGD Checklist for Resolving Problems with Dental Products and Material or the AGD
Checklist for Resolving Problems with Dental Equipment, which appear on the next four pages.
We also encourage you to communicate these guidelines to your membership by printing them in
your constituent newsletter or by distributing them in response to member requests for assistance
in resolving third-party conflicts.
These Checklists were developed by the Dental Practice Council as a method to help those
members experiencing problems with dental equipment, products, and/or material. While AGD
staff is advised of these problems only occasionally, 61.2 percent of the respondents to an AGD
membership survey reported experiencing these types of problems in the last year, and 18.7
percent expressed interest in having the AGD help them resolve these situations. Of those
members reporting these problems, 70.4 percent discussed it with a sales representative and 51.9
percent contacted the manufacturer. Over three-quarters of all respondents (75.2 percent)
reported that they were able to resolve the problem satisfactorily.
The Checklists call for the dentist to review some basic information, and it is hoped that the
practitioner will be able to resolve these situations through the simple, easy-to-follow steps
outlined in each Checklist.
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AGD CHECKLIST FOR RESOLVING PROBLEMS WITH
DENTAL PRODUCTS AND MATERIAL
I
Have you followed the manufacturer’s directions for using the product?
Yes
A.
No
Were there any indications that there might be a problem with using
this material? If yes, please specify what they were.
Yes
B.
No
Is the product still within its recommended shelf life?
Yes
No
II
Have you checked the user’s manual or product information guide, which may
contain helpful “troubleshooting” suggestions?
III
Write down the brand and product name, UPC and product expiration information
(if applicable), your account or customer identification number, the original
invoice, and a description of the problem on a separate piece of paper and attach it
to this form.
IV
Contact the supplier/manufacturer from whom you originally purchased the
product.
A.
Factually describe the problem you’ve experienced and its
implications for your patients.
B.
Communicate your dissatisfaction with the results and politely
request either a refund or replacement. Offer to return any
remaining stock of the product in question to the company. (If a
considerable amount is involved, you may want to ask that it be sent
COD or that they reimburse you for shipping costs).
Determine if you need a prior authorization number—some
companies will refuse deliveries if they do not have a preauthorization number on the return address label.
C.
If this individual cannot offer an acceptable solution, ask to speak
with someone higher up in the firm. At this point, you may want to
put your request in writing, making certain to maintain a
professional and business-like tone and including copies of any
supporting correspondence that might help this individual resolve
your complaint.
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V
VI
Send copies of the above materials to the AGD and Dan Meyer, DDS, Director of
Scientific Information, ADA Council on Scientific Affairs. Request ADA support
and involvement.
You may opt to report the problem you experienced to MedWatch, a voluntary
reporting program operated by the Food and Drug Administration. Health
professionals are encouraged to report adverse events and product problems to
MedWatch, which tracks these types of complaints regarding products and
materials that are under the purview of the FDA.
Contact MedWatch by calling 800.FDA.1088 or online at www.fda.gov/medwatch.
*PREVENTIVE TIPS*

Maintain copies of invoices and product usage materials.

Determine the age of the product—it cannot perform at optimum levels if it
is beyond its useful shelf life date.
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AGD CHECKLIST FOR RESOLVING PROBLEMS WITH
DENTAL EQUIPMENT
I
Have you followed the manufacturer’s recommended maintenance schedule?
Yes
A.
No
Have there been previous indications that there might be a problem
with the equipment?
Yes
B.
No
How old is the equipment? _____ Years
_____ Months
Has it recently been moved or undergone any physical disturbance?
Yes
II
No
C.
Check the power switch, inline fuses, electrical plug, and circuit
breaker.
D.
For air and water problems, make certain that filters and traps are
clean and unblocked.
Have you checked the user’s manual and followed its recommended
“troubleshooting” suggestions?
Yes
No
III
Jot down the brand name, model number, your account or customer identification
number, the original invoice, and a description of the problem on a separate piece
of paper and attach it to this form. Locate the warranty and determine if the item is
still covered.
IV
Contact the supplier/manufacturer from whom you originally purchased the
product.
A.
Factually describe the problem you’ve experienced and its
implications for your patients.
B.
Communicate your dissatisfaction with the results and politely
request a refund, a replacement, or a free service call. If you want to
return the product to the company, ask to ship it COD or request
reimbursement for your shipping costs. Determine if you need a
prior authorization number—some companies refuse deliveries that
do not have a pre-authorization number on the return address label.
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For AGD Constituent Use Only
C.
If this individual cannot offer an acceptable solution, ask to speak
with someone higher up in the firm. Follow up on that conversation
with a memorandum outlining the discussion. Keep the tone of your
letter professional and business-like and include copies of any
supporting correspondence that might help this individual resolve
your complaint.
V
Send copies of the above materials to the AGD and Michael Lynch, DMD, PhD,
Director of Scientific Affairs, ADA Council on Scientific Affairs. Request ADA
support and involvement.
VI
You may opt to report the problem you experienced to MedWatch, a voluntary
reporting program operated by the Food and Drug Administration. Health
professionals are encouraged to report adverse events and product problems to
MedWatch, which tracks these types of complaints regarding products and
materials that are under the purview of the FDA.
Contact MedWatch by calling 800.FDA.1088, or online at www.fda.gov/medwatch.
*PREVENTIVE TIPS*

Develop an interoffice maintenance schedule and list the responsibilities of
each staff person. Determine what needs to be done daily, weekly, monthly,
and annually.

Maintain copies of original invoices, warranties, maintenance agreements and
service bills.

Determine the age of the equipment—if it’s old and frequently breaking, it’s
time to replace it.
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IV. Working Within Organized Dentistry
General
The AGD, in every aspect of its operation, strives to ensure that member dues dollars are applied
judiciously to unique member benefits. The AGD is not interested in duplicating those programs
and services available through other segments of organized dentistry. As a result, while some of
the information reported here is relative to programs and services available through the ADA,
it’s important to realize that the AGD has historically worked within organized dentistry in order
to affect changes that are beneficial to the general dentist. The AGD is also skilled at being able
to maximize on the opportunities available elsewhere within the profession.
In direct response to problems experienced by members, the AGD’s Dental Practice Council has
developed the AGD Checklist for Resolving Problems with Carriers, which appears in Chapter
2. In addition, AGD staff continues to assist members by working with contacts in other
segments of organized dentistry in order to educate third-party payers and benefit plan
purchasers in regards to the inequities present in their benefit plans. These coalitions have
successfully resolved individual problems, and they also minimize or eliminate similar problems
from occurring in the future.
The AGD also helps members by providing our constituent officers with the tools and training
necessary to keep them effective in intervening on behalf of the general dentist. Our goal is to
empower you to resolve most situations locally, which is usually more appropriate and effective
than trying to resolve these problems nationally.
Of course, resources are available from other sources, and a number of valuable sources are
available through the ADA. Highlighted on the following pages are some resources available
from other members of organized dentistry.
CDT
The ADA’s CDT states that the codes and their descriptions are not subject to interpretation. It
is the ADA’s opinion that the uniform use of language will provide an effective mechanism for
communication among dentists, patients and third-parties. Maintaining the CDT as the standard
should eliminate incorrect reporting of procedures, which has been advocated in certain
continuing education courses. Barring the code from interpretation also protects practitioners
from having codes changed by insurance carriers. The CDT is an ongoing review process and
revisions will be written as deemed necessary.
Selecting a Dental Benefits Plan
This brochure, available through the ADA’s Council on Dental Benefit Programs, provides
assistance in designing a dental benefit program. A brochure on the direct reimbursement
benefit model is also available. Either of these resources may be helpful if you are contacted by
an individual or company seeking information prior to developing an employee benefit plan.
Your State Dental Association or Local Society
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AGD leaders must be active within component and constituent dental societies. The best ways
are to work within your state or local dental association and to volunteer on committees and get
the job done. Many times Constituent Dental Care Chairs work closely with their state dental
association to resolve general dentists’ problems or provide guidance in dealing with third-party
problems.
Peer Review
The peer-review process is designed to benefit the patient, the provider, and the third-party
carrier. Through this process, the dental profession reviews and resolves problems or
misunderstandings regarding dental treatment that the provider and patient have been unable to
resolve. Most peer review committees are comprised of at least three members who have
volunteered to serve as impartial mediators. These individuals review the appropriateness or
quality of care and in some instances, the cost of treatment. Their goal is to resolve any situation
in a manner that is satisfactory to all involved parties, without requiring legal involvement. The
recommendation of the peer review committee is conveyed to the provider and patient, and their
decisions are final. Specific information on the process and procedures of your state’s peerreview committee are available through your state dental association.
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V. Current AGD Advocacy Policies
General
The AGD’s policies are directed by the best interest of our general dentist members, while
attempting to balance the views and needs of other areas of the profession.
Before any AGD policy is developed and recommended to the AGD’s House of Delegates
(HOD), AGD staff members research the issue, consider the pros and cons and, if appropriate,
discuss it with peers at other, similarly-impacted organizations. Most advocacy issues are then
referred to the AGD’s Dental Practice Council and/or the AGD’s Legislative & Governmental
Affairs (LGA) Council.
The policy recommendations of the council(s) are then referred to the AGD’s Board of Trustees
or HOD, as appropriate, for consideration and voting.
Advocacy Issues and the AGD’s Positions
As the Dental Care/Practice Chair within your constituent, you serve as ombudsman for your
colleagues—therefore, it’s imperative that you understand the relevance and impact of any issue
that might affect the dental profession or the general practitioners’ right to practice.
In order to be effective, you must first be aware of the AGD’s policies regarding a variety of
advocacy issues. This chapter highlights the AGD’s stance on the following topics:
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Table of Contents
ADVOCACY POLICIES
2010-11
TABLE OF CONTENTS
Accreditation and Recognition of Non-Specialty Areas ............................................................. 55
ADPAC ......................................................................................................................................... 56
ADPAC donation on dues statement ........................................................................................ 56
Advertising of Credentials ............................................................................................................ 56
Advertising of Credentials ........................................................................................................ 56
Advocacy Fund ............................................................................................................................. 56
American Dental Association ...................................................................................................... 56
Advertising campaign, no AGD position on............................................................................. 56
Liaison with .............................................................................................................................. 56
Requirement by AGD for membership in ................................................................................. 56
Anesthesiology .............................................................................................................................. 57
Cost of providing benefit .......................................................................................................... 57
Training availability .................................................................................................................. 57
Annual Meeting ............................................................................................................................ 57
ADEA, report to House by Legislative and Governmental Affairs Council ............................ 57
Contracts ....................................................................................................................................... 57
Contract analysis service........................................................................................................... 57
Dental Anesthesiology .................................................................................................................. 58
Dental Auxiliaries......................................................................................................................... 58
Advanced Dental hygiene Practitioner Position Statement ...................................................... 58
Courses in expanded duties for ................................................. Error! Bookmark not defined.
Dental team concept .................................................................................................................. 58
Duties which will not perform to be defined ............................................................................ 58
Office personnel manuals ......................................................................................................... 58
Perform under direct supervision of general dentist ................................................................. 59
Recruitment strategies ............................................................................................................... 59
Salaries ...................................................................................................................................... 59
Training, education, and utilization of ...................................................................................... 59
Dental Practice ............................................................................................................................. 60
Amalgam, position statement supporting.................................................................................. 60
Uses for, procedures must be publicly disclosed .................................................................. 60
ANSI MD 156, AGD representative on .................................................................................... 61
Appropriate charges made for administrative work .................................................................. 61
Benefit coverage for dental surgery performed in office .......................................................... 61
Biophosphonate therapy............................................................................................................ 61
Bleaching trays, license should be required for fabrication of.................................................. 61
Child’s first visit to dentist, position on .................................................................................... 62
Claims, prompt payment of....................................................................................................... 62
Closed panel, opposed to .......................................................................................................... 62
Code of procedures, endorsed by AGD .................................................................................... 62
Consultant, ground rules for claims denial ............................................................................... 63
Co-payment and overbilling, waiver of .................................................................................... 63
Corporate Guidelines and Mandates ......................................................................................... 63
Date of manufacture of dental equipment and devices ............................................................. 63
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Dental health education for the public ...................................................................................... 64
Dental hygienists, authority of State Boards of Dental Examiners ........................................... 64
Dental Implants ......................................................................................................................... 64
Dental insurance plan to include all facets of dentistry ............................................................ 64
Dental materials to be used in government-funded dental care programsError! Bookmark not
defined.
Dental products, materials, and medications, opposed to bans on the use of ........................... 65
Dental research, public funding for .......................................................................................... 65
Dentistry's position on a National Health Program ................................................................... 65
Dentist's right to collect a larger fee from patient ..................................................................... 65
Diagnosis and supervision needed for dental treatment ............................................................ 65
Diagnostic tests, dentists’ right to prescribe and perform ......................................................... 65
Environmental “best management” practices ........................................................................... 66
Evidence-based dentistry .......................................................................................................... 66
Definition of ......................................................................................................................... 66
Use of.................................................................................................................................... 66
Fees, adjustment of ................................................................................................................... 66
Fees; i.e., usual, reasonable, customary: definition of .............................................................. 66
First Dental Visit Timing and Establishment of the Dental Home (AAP Policy Proposal) ..... 67
Flexible Spending ..................................................................................................................... 67
Fluoridated public water supplies, public funding for .............................................................. 67
Fluoride in water supplies and toothpaste, position statement .................................................. 67
Freedom of choice provider ...................................................................................................... 67
Health care reform .................................................................................................................... 68
Health care reform criteria ........................................................................................................ 68
Issue priorities for government funding .................................................................................... 69
Licensing................................................................................................................................... 69
Criteria for eligibility ............................................................................................................ 69
Uniform standards for........................................................................................................... 70
Voluntary/Temporary Licensing .......................................................................................... 70
Manpower problems ................................................................................................................. 70
Medically compromised dental patients ................................................................................... 70
Disclosure of relevant information ....................................................................................... 70
Policy statement on treatment of .......................................................................................... 70
Medically indigent, support programs for................................................................................. 72
Medicare, amendment to reimburse dentists for rendering same service as a physician .......... 72
Nutrition and oral health ........................................................................................................... 72
Oral Conscious Sedation, position statement ............................................................................ 73
Parameters of care, ADA .......................................................................................................... 73
Parameters of care, criteria for .................................................................................................. 73
Preferred Provider Organizations ............................................................................................. 74
Prepayment plans ...................................................................................................................... 75
Bill payer system .................................................................................................................. 75
Exclude certain contract language ........................................................................................ 75
Include all phases of preventive dental services ................................................................... 76
Structuring of dental prepayment programs ......................................................................... 76
Public information available to public of dental office safety .................................................. 76
Resource-Based Relative Value Scale ...................................................................................... 76
Rights of employers to provide health care benefits ................................................................. 77
School curricula – oral health education ................................................................................... 77
Soft drink consumption/pouring rights contracts ...................................................................... 77
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For AGD Constituent Use Only
Supervision, definitions of for dental hygienists and other dental auxiliaries .......................... 77
Surgeon General's Report on Oral Health ................................................................................. 78
Implementation plan ............................................................................................................. 78
Third party mechanisms ............................................................................................................ 79
ADA's role in problems with ................................................................................................ 79
Claim contested by dental consultant of ............................................................................... 79
Considerations in deliberating dental health insurance programs ........................................ 79
Consultant of, should make no representation to patient regarding dentist's service or fee . 79
Diagnostic imaging ............................................................................................................... 79
Differentials in levels of reimbursement in .......................................................................... 80
Fee Determination ................................................................................................................ 80
Fee schedules based on utilization reviews considered arbitrary ......................................... 80
Guidelines for handling members’ problems with ............................................................... 80
Not to interfere with dentist's diagnosis and treatment ......................................................... 81
Overpayment recovery practices .......................................................................................... 81
Participation should not be contingent upon participation in government regulated programs81
Reduction/denial of dental benefits must be signed by licensed dentist............................... 81
Regulated by law or state governmental agency .................................................................. 82
Tissue biopsy ............................................................................................................................ 82
TMD policy statement .............................................................................................................. 82
TMJ ........................................................................................................................................... 83
Tooth numbering system........................................................................................................... 83
Untoward responses to products, materials, and medications................................................... 83
Workforce, adequacy of present dental workforce ................................................................... 83
Work force issues, position statement....................................................................................... 84
Dental Consultant......................................................................................................................... 84
Coalition to restore deduction for student loan interest ............................................................ 84
Must be a licensed dentist ......................................................................................................... 84
Dental Education.......................................................................................................................... 84
Deduction of interest paid on student loans .............................................................................. 84
Dental schools, support state funding for.................................................................................. 84
Formal academic process leading to a degree or certificate ..................................................... 85
Four-year curriculum, support of .............................................................................................. 85
Liaison consortium.................................................................................................................... 85
Licensure ................................................................................................................................... 85
Dental Laboratory Techniques .................................................................................................... 86
Dental Materials ........................................................................................................................... 86
Purchasing decisions ................................................................................................................. 87
Dental Practices............................................................................................................................ 87
Open elections and nominations for officers ............................................................................ 87
To be owned and operated by licensed dentists ........................................................................ 88
Dental Students ............................................................................................................................ 88
Financial assistance to, that restricts choice of geographical location of practice .................... 88
Loan program for ...................................................................................................................... 88
Recruiting highly qualified students ......................................................................................... 88
Requiring dental students to repay government capitation loans made to schools ................... 89
Denturism ..................................................................................................................................... 89
Direct Reimbursement .................................................................................................................. 89
Definition of .............................................................................................................................. 89
Promotion of ............................................................................................................................. 89
Dues .............................................................................................................................................. 89
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For AGD Constituent Use Only
Assessment................................................................................................................................ 89
Enteral Conscious Sedation ......................................................................................................... 90
Federal Services ........................................................................................................................... 90
Benefits for military personnel and their dependents ............................................................... 90
Salary reimbursement for military dentists ............................................................................... 90
Special pay for uniformed services ........................................................................................... 91
Fees ............................................................................................................................................... 91
Adjusted for complying with governmental regulations ........................................................... 91
General Dentist ............................................................................................................................. 91
Continued competency.............................................................................................................. 91
Creed of..................................................................................................................................... 91
Coordinate and manage dental health ....................................................................................... 92
Definition of .............................................................................................................................. 92
Parity with physicians in all remuneration ................................................................................ 93
Primary dental care provider, defined ....................................................................................... 93
Primary entry point into dental care system.............................................................................. 93
General Practice Residency Program .......................................................................................... 93
Commission on accreditation urged to require that directors of GPR's be general dentists ..... 94
Geriatric Care ............................................................................................................................... 94
Health Maintenance Organizations (HMO’s) ............................................................................ 94
Providing funds for HMOs ....................................................................................................... 94
Health Planning ........................................................................................................................... 94
Organized dentistry to provide input for ................................................................................... 94
Support to repeal Health Planning Act ..................................................................................... 94
HIV ............................................................................................................................................... 94
HIV-infected patients, policy on ............................................................................................... 94
HIV testing of dental personnel ................................................................................................ 95
Statement on disclosure and infection control .......................................................................... 95
Hospital Dentistry Privileges........................................................................................................ 95
Implants ........................................................................................................................................ 95
Pre-doctoral education .............................................................................................................. 96
Infection Control Measures Urged .............................................................................................. 96
Infectious Waste ........................................................................................................................... 96
State and government regulation .............................................................................................. 96
Insurance, Malpractice ................................................................................................................. 97
Legislation .................................................................................................................................... 97
Access to dental care ................................................................................................................. 97
Incentives for dentists to practice in underserved areas ....................................................... 97
Legislative agenda for providing .......................................................................................... 98
AGD opposes limiting political or PAC contributions ............................................................. 99
Air Force Assistant Surgeon General, Rank of ......................................................................... 99
Cash method of accounting, not accrual ................................................................................... 99
Community Health Centers..................................................................................................... 100
Deduction for member dues .................................................................................................... 100
Dental Lab Disclosure............................................................................................................. 100
Federal Trade Commission ..................................................................................................... 100
FTC's efforts to pre-empt state laws re corporate ownership.................................................. 100
General Practitioner's role as gatekeeper for oral health......................................................... 101
Government relations manager ............................................................................................... 101
Government subsidized health care programs ........................................................................ 101
Guidelines for dealing with state legislation ........................................................................... 101
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Indigent population, AGD as a voice for the .......................................................................... 102
Language interpretation at provider’s expense ....................................................................... 102
Legislative or regulatory mandates with inadequate scientific basis ...................................... 102
Link between periodontal disease and low birth-weight babies ............................................. 102
Luken Lee Amendment, endorsement of ADA's position ...................................................... 102
Managed care, AGD’s legislative priorities regarding ........................................................... 103
Mandating national licensure .................................................................................................. 104
Mandating preferred provider organizations........................................................................... 104
Military dentists, special pay and incentives for ..................................................................... 104
National Practitioner Data Bank ............................................................................................. 104
NIDCR .................................................................................................................................... 105
Nitrous oxide inhalation sedation ........................................................................................... 105
Prohibiting latex use without documented scientific evidence ............................................... 105
Protect dental insurance as a fringe benefit ............................................................................ 105
Public disclosure of information in National Practitioner Data Bank..................................... 105
Public Health Service Surgeon General .................................................................................. 106
Sales tax on professional services - AGD opposition ............................................................. 106
State over federal regulation of the dental profession............................................................. 106
Student Loan Interest Deduction ............................................................................................ 106
Tax credit in states with reimbursement rates below 75th percentile ...................................... 106
Tobacco Cessation Treatment ................................................................................................. 106
Tobacco settlement earmarked for health care ....................................................................... 107
Veterans Administration Dental Director ............................................................................... 107
Water quality during routine dental treatments should be appropriate ................................... 107
Licensing..................................................................................................................................... 107
Limited to dentists and dental hygienists ................................................................................ 107
Licensure .................................................................................................................................... 107
By credentials ......................................................................................................................... 107
Limitation of Practice ................................................................................................................. 108
Malpractice Insurance and Litigation ....................................................................................... 108
Defending their capabilities to render dental procedures ........................................................ 108
Mandated Health Benefits ......................................................................................................... 108
AGD policy on ........................................................................................................................ 108
National Health Program, Dentistry’s Position on ................................................................... 109
National Practitioner Data Bank ............................................................................................... 109
OSHA .......................................................................................................................................... 109
AGD efforts to control regulations relating to infectious waste control ................................. 109
AGD influence in adopting guidelines.................................................................................... 109
AGD supports the ADA’s position on OSHA’s anticipated rule on Workplace Safety & Health
................................................................................................................................................ 110
Worker safety regulation, opposition ...................................................................................... 110
Patient Records ........................................................................................................................... 110
Confidentiality of .................................................................................................................... 110
Pediatric Dentistry ...................................................................................................................... 110
Defined.................................................................................................................................... 110
Peer Review Committees ............................................................................................................ 110
For general dentists ................................................................................................................. 110
PSROs (Professional Standards Review Organizations) ........................................................ 111
Quality control review by ....................................................................................................... 111
Seek general practitioner representation on ............................................................................ 111
Post Graduate Training.............................................................................................................. 111
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Availability for all recent graduates ........................................................................................ 111
Public Information ..................................................................................................................... 112
Monitoring dental health messages to the public .................................................................... 112
Radiographs ................................................................................................................................ 112
Dental assistants must be properly trained to use ................................................................... 112
Submission to insurance carriers ............................................................................................ 112
Salaried Dentists ......................................................................................................................... 112
Sedation ...................................................................................................................................... 113
Adequate facilities for teaching .............................................................................................. 113
Teaching of, at the undergraduate and CE levels.................................................................... 113
Smoking ...................................................................................................................................... 113
AGD position on use of Tobacco............................................................................................ 113
Specialty License Laws............................................................................................................... 113
Specialty Listings ........................................................................................................................ 114
State Board of Dentistry ............................................................................................................. 114
Sterilization ................................................................................................................................. 115
Procedures ............................................................................................................................... 115
Surveys ........................................................................................................................................ 115
Of dental schools, annually ..................................................................................................... 115
Table of Allowances ................................................................................................................... 115
Acceptable reimbursement mechanism .................................................................................. 115
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POLICIES
Accreditation and Recognition of Non-Specialty Areas
2005:5-H-7
“Resolved, that the AGD adopt the following position regarding the
accreditation and recognition of non-specialty areas of general dentistry:
AGD Position on
the Accreditation and Recognition of Non-Specialty Areas
The AGD supports excellence in general dentistry and the pursuit of
professional development through lifelong learning. Advanced education
should meet independent standards so that the education is valid and
provides the framework for excellent patient care. General dentistry is not
just treating patients – it is being the educated gatekeeper of oral health so
that the patient is provided with all the available options for treatment. The
knowledge of when to treat and when to refer, and to whom, is the
responsibility of the general dentist. The general dentist’s emphasis is on
primary care. They guide patients to efficient, cost effective treatment
while maintaining continuity of care.
AGD supports the responsibility of the Commission on Dental
Accreditation (CDA) to develop accreditation standards for all formal
education programs in dentistry, whether they are in an ADA-recognized
specialty, in general dentistry or in a non-specialty area of general dentistry.
This is not changing the scope of practice for general dentists and dental
specialists, nor is it adding new specialties. If non-specialty areas that
provide formal advanced education can seek accreditation then the public
will benefit.
The general dentist is the coordinator of care and as such should be able to
inform the patient of all available treatment options. The general dentist
should have access to education in all areas of dentistry, including advanced
education programs and continuing dental education.
The specialist is a partner in dental treatment that is dependent upon patient
referral from a general dentist. If general dentists have had additional
education and training they are able to provide better patient care, treatment
planning and know better when to refer to a specialist or another general
dentist. This will strengthen the profession.
It is not as important an issue that the public understand the scope of
practice between practitioners as it is that they understand how oral health
affects their overall health. Clear messages about why it is important to see
the general dentist twice a year would be powerful messages to the majority
of the public who are interested in their health. Whether the public sees a
55
For AGD Constituent Use Only
specialist or a general dentist should be on the recommendation of their
general dentist
The ADA is uniquely poised to promote the image of modern dentistry to
the public. It is not the role of the ADA to make patients aware of how to
select a specialist – that is the role of the referring general dentist. The
ADA should focus on getting the public to the dentist and in working within
the legislative arena to see that access to care is improved.
As CDA accredits advanced education programs in general dentistry, the
ADA should consider mechanisms for recognizing board certification in
general dentistry areas, including the American Board of General
Dentistry.”
ADPAC
ADPAC donation on dues statement
*87:52-H-7
RESCINDED
Advertising of Credentials
Advertising of Credentials
2008:314R-H-7
“Resolved, that the AGD adopt Announcement of Credentials to the Public:
A Position Paper as its policy on the announcement of its FAGD and
MAGD credentials.”
Advocacy Fund
2009:315R-H-7
“Resolved, that the AGD create an Advocacy Fund.”
American Dental Association
Advertising campaign, no AGD position on
98:19-H-7
“Resolved, that the AGD take no formal position on the ADA’s institutional
advertising campaign and accompanying assessment.”
Liaison with
*76:34-H-1
RESCINDED
Requirement by AGD for membership in
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79:15-H-6
REVISED
HOD 7/99
“Resolved, that it shall continue to be AGD policy to encourage
membership in the American Dental Association, the Canadian Dental
Association, or the National Dental Association.”
Anesthesiology
Cost of providing benefit
2002:29-H-7
“Resolved, that the Academy of General Dentistry believes patients with
physical, developmental, emotional, or medically compromising conditions
may require sedation/general anesthesia in private office, hospital, or
surgical center settings for the safe and effective treatment of dental disease
and/or injury, and be it further
Resolved, that sedation and/or general anesthesia and related facility costs for
the treatment of dental disease and/or injury in these patients should be a
covered benefit in all group medical benefit policies and Medicaid.”
Training availability
90:54-H-7
"Resolved, that the Academy of General Dentistry work with the American
Dental Association and the American Dental Education Association to
recommend that dental schools and hospital-affiliated teaching institutions
establish anesthesiology programs so that dentists seeking in-depth
education in anesthesiology will have such training available."
94:14.2-H-7
"Resolved, that educational opportunities be available so that general
dentists will have adequate opportunity for training in dental anesthesiology
in order to provide optimum pain and anxiety control for the public."
Annual Meeting
ADEA, report to House by Legislative and Governmental Affairs Council
94:22.2-H-7
"Resolved, that the Legislative and Governmental Affairs Council
annually report to the Academy of General Dentistry's House of Delegates
on the activities of dental schools and other organizations as they relate to
the political concerns of general dentistry."
Contracts
Contract analysis service
88:47-H-7
2008:110-H-7
AMENDED HOD 2008
“Resolved, that Policy 88:47-H-7 be amended so that it reads:
“Resolved, that the Academy of General Dentistry offer to its members a
contract analysis service, and be it further
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For AGD Constituent Use Only
Resolved, that members be encouraged to seek the advice of their own
attorney before deciding to sign a contract, and be it further
Resolved, that the Dental Care Council develop means to educate Academy
of General Dentistry members about the ramifications of provider
contracts.”
Dental Anesthesiology
94:14.1-H-7
RESCINDED HOD 2007
2007:302-H-6
“Resolved, that the HOD Policy 94:14.1-H-7, which recognizes
anesthesiology as a specialty, be rescinded.
94:14.1-H-7
Resolved, that the Academy of General Dentistry supports the recognition
of dental anesthesiology as a dental specialty”
Dental Auxiliaries
Advanced Dental hygiene Practitioner Position Statement
“Resolved, that the AGD adopt the Position Statement on the Advanced
Dental Hygiene Practitioner (ADHP) Concept.”
2008:322-H-7
Dental team concept
86:30-H-7
"Resolved, that the Academy of General Dentistry supports the dental team
concept as the best approach to providing the public with quality
comprehensive dental care, and firmly supports direct supervision of the
practice of dental hygiene, and be it further
Resolved, that this policy be conveyed to the American Dental Association,
the American Dental Hygienists Association, and state and provincial
boards of dental examiners, and be it further
Resolved, that Policy #85:25-H-7 be rescinded."
Duties which will not perform to be defined
73:23-H-10
"Resolved, that those states permitting expanded duties by dental auxiliaries
define those duties which dental auxiliaries will not be permitted to perform
in compliance with individual state dental practice acts."
Office personnel manuals
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For AGD Constituent Use Only
77:10-H-6
RESCINDED
Perform under direct supervision of general dentist
73:24-H-10
"Resolved, that all duties performed by any dental auxiliary must be done
under the direction and control of the dentist and that he or she be directly
responsible for the actions of his or her auxiliaries performing those duties."
Recruitment strategies
91:48-H-7
"Resolved, that the Academy of General Dentistry believes that its
individual members can make a significant contribution to resolving the
dental auxiliary shortage by attempting to recruit potential dental team
personnel, and be it further
Resolved, that the AGD play a key role in solving the dental auxiliary
shortage by:
1.
Encouraging AGD members to recruit dental auxiliaries each year,
using materials provided by the ADA.
2.
Educating AGD members to properly manage dental auxiliaries
through:
a.
b.
c.
d.
a request that the AGD editor publish an appropriate article
in Impact.
a request that the Council on Annual Meetings and
International Conferences establish a course on this subject
Suggesting to the AGD Foundation to offer an appropriate
practice management course showing dentists how to
properly manage and therefore retain dental auxiliaries.
Asking AGD constituents to publish appropriate articles on
this subject, tailored to local needs."
Salaries
77:9-H-6
RESCINDED
Training, education, and utilization of
73:25-H-10
"Resolved, that definite educational requirements be instituted for the
proper training of dental auxiliaries in expanded duties and the AGD should
study existing ADA approved programs to determine the appropriate
educational requirements."
74:13-H-11
"Resolved, that in the training, education and utilization of dental
auxiliaries for the purpose of assisting the dentist in providing high quality
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dental care through performance of expanded functions, it shall be the
recommendation of the Academy of General Dentistry that such auxiliaries
be permitted to perform under the direct supervision of the dentist those
functions which do not require the professional skill and judgment of the
dentist and are in compliance with laws of states which have provisions for
expanded functions, and be it further
Resolved, that the dentists, and only the dentist, is responsible for the
examination, making the diagnosis and formulating the plan of treatment,
performing surgical or cutting procedures on hard or soft tissue, fitting and
adjusting corrective and prosthodontic appliances, prescribing therapeutic
agents and making impressions for other than study casts, and be it further
Resolved, that final decisions related to dental practice and utilization of
dental auxiliaries rest with the state society and the state board of dentistry,
and be it further
Resolved, that the AGD recognize the necessity of effectively utilizing
dental auxiliaries to maximize the efficient use of the dentist's time and
skills."
Dental Practice
Amalgam, position statement supporting
2002:24-H-7
“Resolved, that based on current scientific evidence, including the Food and
Drug Administration’s February 2002 Consumer Update on Dental
Amalgam, the Academy of General Dentistry maintains that amalgam is
safe and effective as a dental restorative material.”
Analyzed health care data
Methodology and source of funding must be disclosed if used for Benefit
determination
2000:24-H-7
“Resolved, that if information gathered from analyzed healthcare data is
used for either benefit determination or dentist preferential selection, then
the methodology and source of funding involved in the analysis must be
publicly disclosed and verified by a process that ensures the quality,
integrity, and validity of the analysis methodology.”
Uses for, procedures must be publicly disclosed
2000:23-H-7
“Resolved, that the Academy of General Dentistry supports the concept that
if health care data is analyzed, it should only be used to advance scientific
knowledge or improve the oral health of the patient, while still allowing for
professional judgments by practitioners, and be it further
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Resolved, that the procedures involved in the analysis must be publicly
disclosed and reviewed by the affected communities of interest in order to
ensure the quality, integrity, and validity of the analysis methodology.”
ANSI MD 156, AGD representative on
97:25-H-8
“Resolved, that the Academy of General Dentistry recognizes the problem
of providing the general practitioner with meaningful information upon
which to base purchasing decisions, and be it further
Resolved, that the following strategies be implemented in order to
accomplish this purpose:
1.
Maintain an AGD representative on ANSI MD 156.
2.
Recommend members to participate on ANSI subcommittees through
the Dental Care Council Chairperson.
3.
Relay to the ADA AGD's concerns with regard to having the practicing
dentist more informed in order to make proper purchasing decisions.
4.
Obtain feedback from our members on materials with which they’ve
experienced problems.”
Appropriate charges made for administrative work
75:28-H-10
"Resolved, that the AGD recognize that it is ethical and proper for
appropriate charges to be made when a dentist completes a claim form, a
narrative report or other paperwork requiring secretarial, clerical, and
professional time as long as the fee is identified."
Benefit coverage for dental surgery performed in office
79:35-H-6
"Resolved, that AGD support the inclusion of clauses in hospitalization and
surgical benefits contracts that provide for coverage for dental surgery in
the office setting if such surgery would normally be covered were the
patient hospitalized for the procedure."
Biophosphonate therapy
2007:27R-H-8
“Resolved, that the AGD communicate the potential serious oral sequelae
of bisphosphonate therapy, including osteonecrosis, to the medical and
dental communities, and to inform patients of such risk and encourage
patients to seek dental care prior to initiating bisphosphonate therapy."
Bleaching trays, license should be required for fabrication of
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2001:27-H-8
“Resolved, that the Academy of General Dentistry believes that supervising
or providing materials or methodology for consumers to make intraoral
impressions constitutes the practice of dentistry, which requires an
appropriate license in the state or province where the individual is being
treated, and be it further
Resolved, that directing a dental laboratory to fabricate intraoral appliances
and devices (including bleaching trays) constitutes the practice of dentistry,
which requires an appropriate license in the state or province where the
individual is being treated, and be it further
Resolved, that in order to protect the health of the public, the Academy of
General Dentistry believes that the fabrication of intraoral appliances and
devices (including bleaching trays) by dental laboratories requires a proper
prescription by a dentist licensed in the state or province where the
individual is being treated.”
Botulinum toxin and cosmetic dermal filler procedures, education in and performance of
2010:308R-H-7 “Resolved, that the AGD supports general dentists receiving education on,
and the performance of botulinum toxin and cosmetic dermal filler
procedures.”
Child’s first visit to dentist, position on
98:24-H-7
“Resolved, that the Academy of General Dentistry officially endorse the
position that a child’s first visit to the dentist should occur within six
months of the eruption of the first tooth.”
Claims, prompt payment of
93:22-H-7
"Resolved, that the Academy of General Dentistry ascribes to the American
Dental Association's policy on the prompt payment of dental claims, which
reads:
'Resolved, that the appropriate agencies of the American Dental
Association, and its constituent dental societies, be urged to seek legislation
which would require all public and private third-party payers to reimburse
dental claims within (15) business days from receipt of the claim by the
third-party payer or be penalized for failure to do so.'"
Closed panel, opposed to
*72:9-H-10
RESCINDED HOD 7/99
Code of procedures, endorsed by AGD
74:12-H-11
"Resolved, that the AGD endorse the principle of one code of procedures
for dentistry, and be it further
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Resolved, that whenever the ADA Council on Dental Benefit Programs or
one of its sub-committees considers revisions in the ADA code the
Academy of General Dentistry be permitted direct input into such revisions
by having representation at those meetings, and be it further
Resolved, that the AGD urge the American Dental Association to take steps
to assure that the approved code is used throughout the purview of the
Academy of General Dentistry."
Consultant, ground rules for claims denial
93:27-H-7
"Resolved, that when a third-party dental consultant applies an alternative
benefit provision to the treatment plan submitted by the provider dentist, or
when a third-party dental consultant denies benefits for reasons other than
contract exclusions, the dental consultant must sign the report and provide
his/her telephone number, and be it further
Resolved, that the AGD promote this concept to the American Dental
Association, the Canadian Dental Association and third-party payment
groups."
Co-payment and overbilling, waiver of
93:23-H-7
"Resolved, that the Academy of General Dentistry adopt the American
Dental Association's policies regarding waiver of copayment and
overbilling, which read:
'Resolved, that constituent dental societies be urged to pursue enactment of
legislation that:
1)
2)
prohibits systematic non-disclosure of waiver of patient
co-payment/overbilling by a dentist and
prohibits bad faith insurance practices by third party payers, consistent
with Association policy, and be it further
Resolved, that third-party payers be urged to support this legislative
objective.'"
Corporate Guidelines and Mandates
2009:319S-H-7
“Resolved, that the AGD is opposed, as unduly burdensome to general
dentistry and the patients it serves, to all corporate mandates that require
specified quantities of utilization of the corporation’s products in patient’s
dental treatment, without any qualitative assessment of each dentist’s
proficiency with the products and without substantial clinical evidence of
patient harm as a result of utilization in less than the specified quantities, as
prerequisites for continued access to the use of the corporation’s product.
Date of manufacture of dental equipment and devices
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81:26-H-7
"Resolved, that AGD encourage that ADA specifications for dental
materials and devices include an expiration date where applicable, and
when not applicable a date of manufacture or packaging, and be it further
Resolved, that the type of date utilized be clearly indicated and separate
from a lot or serial number."
Dental health education for the public
81:33-H-7
"Resolved, that AGD support the concept of having public funds used to
support dental health education for the public."
2006:23R-H-7
“Resolved, that AGD seeks to educate the public about the potential
financial & health risks, due to lack of legal and contractual insurance
recourse when medical & dental care is sought outside of the United States
and Canada.”
Dental hygienists, authority of State Boards of Dental Examiners
92:34-H-7
"Resolved, that because of the nature of dentistry and the manner in which
it is delivered to the public, it is the policy of the Academy of General
Dentistry that dental hygiene should remain under the authority of the
various state boards of dental examiners and that dental hygiene education
should remain under the purview of and be accredited by the Joint
Commission on Dental Accreditation."
Dental Implants
2008:317-H-7
“Resolved, that the AGD policy shall be that dental implants are an
accepted modality of treatment.”
2009:301S-H-7
“Resolved, that the AGD support legislation requiring insurance carriers to
cover reimbursement for surgical implant placement and restoration.”
2009:306-H-7
2009:307-H-7
“Resolved, that, when one or more dentists are involved in dental implant
therapy, there should be mutual agreement of the restorative objectives by
all parties, including the patient, before any invasive therapy is
undertaken.”
"Resolved, that the AGD adopt the Educational Objectives for the Provision
of Dental Implant Therapy.”
Dental insurance plan to include all facets of dentistry
82:32-H-7
"Resolved, that the AGD recognize that an optimum dental benefits plan
includes all facets of dentistry."
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Dental materials, products, and/or medications, use in oral healthcare
2010:306RS1-H-7
“Resolved, that HOD Policy 99:36-H-7 and HOD Policy 2002:25-H-7 be
rescinded and be it further,
Resolved, that the AGD take appropriate action when necessary to ensure
that safe and effective dental materials, products, and/or medications
remain approved for use in oral healthcare.”
Dental research, public funding for
81:35-H-7
"Resolved, that the AGD support the concept of using public funds if
available for dental research."
Dentistry's position on a National Health Program
80:25-H-7
"Resolved, that AGD's Guidelines for Dentistry's Position on a National
Health Program and other relevant AGD and ADA policy be reviewed in
relation to any future legislation mandating dental benefits."
Dentist's right to collect a larger fee from patient
77:14-H-6
"Resolved, that the AGD is opposed to any administrative procedure by a
third party payment mechanism which interferes with the dentist's right to
collect from a patient a fee greater than that allowed by the carrier's benefit
structure except when a dentist has agreed to become a participant in a
benefits program that utilizes a usual, customary, and reasonable method of
reimbursement as payment in full.”
Diagnosis and supervision needed for dental treatment
2003:16-H-7
“Resolved, that dental treatment, including the placement of dental sealants
and fluoride varnishes, is most effectively and successfully accomplished
following a proper diagnosis by, and under the supervision of a licensed
dentist in compliance with the regulations of the state or province, and in a
dental office setting that ensures optimal treatment outcomes.”
Diagnostic tests, dentists’ right to prescribe and perform
97:26-H-8
“Resolved, that the Academy of General Dentistry recognizes that dentists
have the right to prescribe and perform any diagnostic tests deemed
necessary providing that:
1.
The test is required for the oral diagnosis of or treatment planning for
the patient, or the management of a percutaneous injury in a clinical
setting.
2.
The patient has given informed consent.
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3.
The test is accompanied, where appropriate, by adequate pre- and postcounseling.
4.
There is provision for appropriate referral to a physician responsible for
the comprehensive medical care of the patient.”
Environmental “best management” practices
2003:12-H-7
“Resolved, that the AGD urge dentists to employ environmental “best
management” practices as supported and/or promoted by the American
Dental Association and in Canada by the Canadian Dental Association, and
be it further
Resolved, that AGD constituents be encouraged to work with their counterpart dental
societies to adopt and promote environmental best management practices.”
Evidence-based dentistry
Definition of
2000:22A-H-7
“Resolved, that the Academy of General Dentistry believes that evidencebased dentistry is an approach to treatment planning and subsequent dental
therapy that requires the judicious melding of systematic assessments of
scientific evidence relating to the patient’s medical condition and history,
the dentist’s clinical experience, training, and judgment, and the patient’s
treatment needs and preferences.”
Use of
2000:22B-H-7
“Resolved, that evidence-based dentistry be utilized to promote the delivery
of the most effective care for the patient and not for the determination of
dental benefits.”
Fees, adjustment of
93:25-H-7
"Resolved, that the Academy of General Dentistry recognizes that dentists
may, upon occasion, adjust fees to classes of individuals, such as relatives,
clergy, staff, senior citizens, the indigent, and be it further
Resolved, that any occasional fee adjustments should not be reflected in
determination of UCRs by third parties, and be it further
Resolved, that the Academy of General Dentistry recommends that this be
properly recorded in the dentist's records."
Fees; i.e., usual, reasonable, customary: definition of
93:24-H-7
"Resolved, that the Academy of General Dentistry adopt the American
Dental Association's definitions of and policies regarding 'usual, customary
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and reasonable fees,' which read:
'Usual fee' is the fee which an individual dentist most frequently charges for
a specific dental procedure.
'Reasonable fee' is the fee charged by a dentist for a specific dental
procedure which has been modified by the nature and severity of the
condition being treated and by any medical or dental complications or
unusual circumstances, and therefore may differ from the dentist's "usual"
fee or the benefit administrator's "customary" fee.
'Customary fee' is the fee level determined by the administrator of a dental
benefit plan from actual submitted fees for a specific dental procedure to
establish the maximum benefit payable under a given plan for the specific
procedure."
First Dental Visit Timing and Establishment of the Dental Home (AAP Policy Proposal)
2002:22-H-7
Resolved, that the Academy of General Dentistry endorses the American
Academy of Pediatrics Policy Proposal from the AAP Section on Pediatric
Dentistry entitled “First Dental Visit Timing and Establishment of the
Dental Home”, and be it further
Resolved, that the Academy of General Dentistry communicate this
endorsement to the American Academy of Pediatrics.”
Flexible Spending
2008:308-H-7
“Resolved, that the AGD support the expansion of Flexible Spending
Account (FSA) reimbursable health items to include oral health items.”
Fluoridated public water supplies, public funding for
81:32-H-7
"Resolved, that the AGD support the use of public funds to assist local and
state governments in seeing that their public water supplies are adequately
fluoridated."
Fluoride in water supplies and toothpaste, position statement
2002:21-H-7
“Resolved, that based on the Center for Disease Control’s
Recommendations for Using Fluoride, the AGD adopt the following
position statement:
When used appropriately, fluoride is safe and effective in preventing and controlling dental
caries. Regular use throughout life will help protect teeth against decay. All water supplies,
including bottled water, should have appropriate fluoride levels. All fluoridated items,
including toothpaste, should be used as recommended by your dentist.”
Freedom of choice provider
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94:30-H-7
"Resolved, that the Academy of General Dentistry actively support
"freedom of choice" legislation permitting patients to freely choose their
dentist while continuing to utilize their full dental benefits, and be it further
Resolved, that the Academy of General Dentistry actively support "any
willing provider" legislation to allow dentists to enroll at any time and to
freely participate in dental third-party programs."
Health care reform
2009:316-H-7
“Resolved, that the Academy of General Dentistry participate in any
legislative discussions regarding health care reform.”
Health care reform criteria
93:28-H-7
"Resolved, that it is the policy of the Academy of General Dentistry that if
dentistry is to be included in any government health care program reform, it
must:
1)
2)
3)
4)
Be adequately funded to provide broad access;
Permit freedom of choice of dentists;
Be based on fee-for-service; and
Assure high quality dental care.
and be it further
Resolved, in any case where dentistry is included in health care reform, the
AGD support the following six recommendations set forth by the American
Dental Association:
1.
Maintain the advantages of the current dental care and dental benefits
system, which would not require inclusion of dental benefits for
population groups currently receiving regular dental care, and which
would not require public sector participation and subsequent cost
transfer. The Association strongly opposes any change in the tax
deductibility of current dental benefit coverage.
2.
Continue existing policy support for a separate, restructured program
of publicly funded dental benefits for indigent persons. Priority
consideration should be given to programs for children. The
Association urges that these programs be administered in the private
sector wherever possible.
3.
For population groups currently not receiving regular dental care the
Association supports the opportunity for a) small employers purchase
dental plans in the private sector, b) development of cooperative dental
benefit purchasing alliances administered in the private sector.
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4.
The Association recommends that preventive services and educational
programs for children be included in any health system reform
proposal. Preventive services may include but are not necessarily
limited to, fluoridation of community water supplies, oral prophylaxis
and application of topical fluorides and sealants; dietary fluoride
supplements; restoration of carious teeth; maintenance of space
resulting from the early loss of primary teeth and patient education.
5.
The Association recommends that in the event that a more
comprehensive program is enacted, preventive, diagnostic, emergency
services and basic restorative and periodontal care be included for
children and the elderly.
6.
The Association believes that if the Medicare program is expanded to
include coverage for additional dental health care services, we would
endorse the inclusion of a defined dental benefit plan for the elderly
population. These services would be expressly focused on those
elderly who are in long-term residential care or home-bound. Delivery
of these services should not be compromised by discrimination by
category of provider (physician or dentist)."
Issue priorities for government funding
*79:27-H-6
RESCINDED
*81:30-H-7
RESCINDED
94:20-H-7
"Resolved that the following policies be rescinded:
77:20-H-6
Superseded by 1992 House Resolution
79:27-H-6
Outdated
81:30-H-7
Outdated
75:37-H-10
Outdated
91:49-H-7
Superseded by 1992 House Action on reform
Licensing
Criteria for eligibility
2002:28-H-7
“Resolved, that the Academy of General Dentistry believes that to be eligible to apply for
an initial license to practice dentistry in the United States or Canada, the candidate must
have:
1.)
Graduated from a dental college with training that is equivalent or
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2.)
3.)
higher than that provided by a dental college approved by the
American Dental Association’s Commission on Dental Accreditation
or the Canadian Commission on Dental Accreditation,
Passed Part I and Part II of the National Board Exam (or the National
Dental Examining Board Exam in Canada), and
Passed a state or provincial licensing examination, or its equivalent, as
determined by the state or provincial board of dentistry, and any
additional requirements.”
Uniform standards for
2002:27-H-7
“Resolved, that the AGD actively support a uniform standard for licensing
dentists in all U.S. states and Canadian Provinces, and be it further
Resolved, that access to oral health care for underserved populations should be
addressed by maintaining uniformly enforced licensing standards that would prevent
an unequal and unacceptable two-tier level of care, and be it further
Resolved that the AGD believes that access to care in underserved areas
should be solved by instituting adequate financial incentives or loan
forgiveness to properly licensed dentists.”
Voluntary/Temporary Licensing
2009:311-H-7
“Resolved, that the AGD approve the policy Supporting Issuance of
Volunteer/Temporary Licenses for Dentists Licensed in Different States”
“Resolved, that the AGD supports the issuance of a temporary license to do
volunteer dentistry by dental licensing boards to dentists who are licensed
in another state or province when such dentists are seeking such license in
order to provide volunteer or charity care.”
Manpower problems
*79:34-H-6
RESCINDED HOD 7/99
Medically compromised dental patients
Disclosure of relevant information
88:54-H-7
"Resolved, that all legislation and regulations to protect confidentiality of
information on medically compromised or handicapped patients provide for
disclosure of relevant information to members of the individual's direct
care-giving team."
Policy statement on treatment of
88:48-H-7
"Resolved, that the AGD adopt the following policy:
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AGD POLICY STATEMENT ON TREATMENT
OF MEDICALLY COMPROMISED DENTAL PATIENTS
With the aging of the population and the spread of infectious diseases,
dentists will encounter growing numbers of medically compromised
patients, including those with infectious diseases. The general dentist, as
primary dental care provider, plays the key role in providing and
coordinating dental care for such patients.
In this role dentists have responsibilities to all patients, staff and other
parties which they are ethically bound to fulfill.
Responsibilities to the Medically Compromised Patient
o
To treat the patient with kindness and compassion, regardless of the
nature of the patient's condition.
o
To be sufficiently educated to evaluate the dental health of a medically
compromised patient and to consult with physicians, when necessary,
regarding the patient's medical status.
o
To provide appropriate treatment within the dentist's realm of
competence.
Responsibilities to Dental Staff
o
To ensure that staff are trained in emergency care, the management of
special health conditions and the management of medically
compromised patients.
o
To advise staff of the health status of each patient so they may employ
appropriate procedures and avoid procedures that may place
themselves or the patient at unnecessary risk.
o
To ensure that all staff members are properly educated so they
understand that infection control measures, including barrier
techniques are in place and practiced routinely to protect them against
disease. With this understanding they can properly render
compassionate care to a medically compromised patient.
Responsibility to Other Parties
o
Dentists must observe state and/or federal laws and regulations that
require providers to protect the confidentiality of the patient.
Ethical Considerations for Treating HIV Positive Patients
The AGD believes that dentists are obligated to observe the American
Dental Association's Principles of Ethics and Code of Professional Conduct
in the treatment of all patients including those who are medically
compromised, of which HIV positive patients are a part."
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Medically indigent, support programs for
77:18-H-6
"Resolved, that every effort be made to have indigent dental care programs
structured so that they take into consideration the current cost basis
involved in providing the dental services."
81:31-H-7
"Resolved, that AGD support viable programs to provide dental care to the
needy elderly and medically indigent."
81:34-H-7
"Resolved, that the AGD support the concept of using public funds if
available to provide dental care for the medically indigent."
Medicare, amendment to reimburse dentists for rendering same service as a physician
79:28-H-6
"Resolved, that the AGD support the concept of amending Medicare so that
a dentist shall be reimbursed for a dental service rendered under this
program if a physician would have been reimbursed for rendering the same
service."
Nutrition and oral health
2004:14-H-7
“Resolved, that the Academy of General Dentistry encourages dentists to
maintain ongoing knowledge of nutritional recommendations such as in the
Dietary Guidelines for Americans published by the U.S. Department of
Agriculture and the U.S. Department of Health and Human Services and
their Canadian counterparts, as they relate to general and oral health and
disease, and be it further
Resolved, that the Academy of General Dentistry encourage dentists to
effectively educate and counsel their patients about proper nutrition and oral
health, including eating a well balanced diet and limiting the number of highly
cariogenic between-meal snacks, and be it further,
Resolved, that the Academy of General Dentistry encourage constituent
academies to work with school officials to ensure that school food services,
including vending services and school stores, provide nutritious food selections,
and be it further
Resolved, that the Academy of General Dentistry opposes targeting children in the promotion
and advertisement of foods low in nutritional value and highly cariogenic foods and beverages
and be it further
Resolved, that the Academy of General Dentistry encourages continued federal
support for programs that provide nutrition services and education for infants,
children, pregnant women and the elderly, and be it further,
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Resolved, that the Academy of General Dentistry encourages the appropriate
government agencies to prevent the distribution of non-nutritious and highly
cariogenic foods and beverages under federal nutrition service programs.”
Oral Conscious Sedation, position statement
2005:2R-H-7
“Resolved, that the AGD position on Oral Conscious Sedation is:
1. The Academy of General dentistry believes that the general dentist must
have access to appropriate training in the area of anxiolysis and oral
conscious sedation. The AGD further believes that continuing education
opportunities must continue to be developed to make these courses
available to the general practitioner.
2. “Anxiolysis” means removing, eliminating or decreasing anxiety. This
may be accomplished by the use of medication that is administered in an
amount consistent with the manufacturer’s current recommended
dosage and/or judgment on the part of the clinician with or without
nitrous oxide and oxygen. When the intent is anxiolysis only, the
definition of enteral and/or combination inhalation-enteral conscious
sedation (combined conscious sedation) does not apply.
3. The Academy of General Dentistry supports the rights of the general
dentist to use professional judgment in deciding the appropriate dose for
each patient situation, respecting safe dosing parameters.
4. The Academy of General Dentistry believes that each constituent should
be in close contact with their licensing boards to communicate the
AGD’s position on this issue.”
Parameters of care, ADA
91:46-H-7
"Resolved, that the Board be directed to take a firm position that protects
and accurately represents the interests of practicing general dentists on the
development of parameters of care prior to consideration by the ADA
House of Delegates after weighing all available evidence on the issue,
including input from the Chairman of the AGD Dental Practice Council."
Parameters of care, criteria for
93:26-H-7
"Resolved, that any parameter of care established for the entire dental
profession should be:
1.
Condition-based;
2.
Equally applicable to all dental care providers;
3.
Universally accepted with the dental profession; and
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4.
Developed by the American Dental Association with appropriate
representation by the affected communities of interest, including the
AGD as the representative of general practitioners; and be it further
Resolved, that the AGD's Dental Practice Council shall continue to monitor
the status of parameters and attempt to achieve AGD representation in the
development of parameters, and be it further
Resolved, that the AGD reserves the right to develop its own parameters
should the need arise."
94:32-H-7
"Resolved, that any parameter of care established for the entire dental
profession should be:
1.
Condition-based;
2.
Equally applicable to all dental care providers;
3.
Universally accepted within the dental profession; and
4.
Developed by the American Dental Association with appropriate
representation by the affected communities of interest, including the
AGD as the representative of general practitioners; and be it further
Resolved, that the AGD's Dental Practice Council shall continue to monitor
the status of parameters and attempt to achieve AGD representation in the
development of parameters, and be it further
Resolved, that the AGD reserves the right to develop its own parameters or
oppose the development of parameters should the need arise."
Preferred Provider Organizations
84:26-H-7
"Resolved, that the Academy of General Dentistry use whatever means are
available to ensure that the following provisions are included in and made a
part of any state and/or federal law mandating and/or regulating preferred
provider organizations:
A.
Patients' freedom of choice of provider must be guaranteed.
B.
Preferred provider policies or contracts and preferred provider
subscription contracts shall provide the same benefits level to the
patient whether rendered by non-preferred providers or preferred
providers.
C.
No dentist willing to meet the terms and conditions offered by a PPO
shall be excluded.
D.
All types of licensed health care providers whose services are
required shall have the same opportunity to qualify for payment as a
preferred provider under any such policies.
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E.
The terms and conditions of any PPO policies or contracts shall not
discriminate against or among health care providers.
F.
A preferred provider subscription contract should be defined as a
contract which specifies how services are to be covered by the plan
when rendered by non-participating providers and by preferred
providers.
G.
Preferred provider policies or contracts should be defined as
insurance policies or contracts which specify how services are to be
covered by the plan when rendered by preferred and non-preferred
providers.
H.
When preferred provider organizations are promoted to the public,
they cannot do so with any implications of superiority, and all
promotional materials used by PPOs must state if a preferred
provider is a reduced fee contract.
I.
The PPO shall make provision for a periodic adjustment in level of
reimbursement based on the Consumer Price Index or some other
equitable basis.
And be it further
Resolved, that the Academy of General Dentistry encourage its Constituent
Academies to work toward building these safeguards into any state and/or
federal law mandating and/or regulating preferred provider organizations.
And be it further
Resolved, that the Academy of General Dentistry transmit this position to
the American Dental Association's Dental Practice Council Programs."
Prepayment plans
Bill payer system
78:24-H-6
"Resolved, that the AGD recognize the 'bill payer system' (direct
reimbursement) as one of the acceptable forms of dental prepayment."
Exclude certain contract language
77:12-H-6
"Resolved, that in the interest of providing the best possible level of dental
care for the patient, the Academy of General Dentistry is opposed to the
inclusion of 'least expensive but adequate treatment', 'alternate mode of
treatment', or similar contract language, in prepayment dental plans, and be
it further
Resolved, that such language be eliminated from prepayment contracts
wherever possible, and be it further
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Resolved, that this type of language in existing dental contracts be
implemented in such a manner so as not to impugn the integrity of the
attending dentist or intrude upon the patient-dentist relationship by either
informing or implying that an alternate mode of treatment is appropriate, or
influence the patient in any way in his choice of the attending dentist's
treatment, and be it further
Resolved, that the 1976 House of Delegates' substitute resolution for #35 be
rescinded."
Include all phases of preventive dental services
81:29-H-7
"Resolved, that the AGD recognize the necessity of having all phases of
preventive dental services in the dentist's office included in dental
prepayment plans, and be it further
Resolved, that AGD request the appropriate agencies of the American
Dental Association to consider the development of a position statement that
would serve to accomplish this purpose."
Structuring of dental prepayment programs
77:17-H-6
"Resolved, that third party mechanisms, including government programs,
take these differences into consideration in structuring dental prepayment
programs, and be it further
Resolved, that dental prepayment programs for the non-indigent have a
provision whereby the patient will pay the differences between the fee
authorized under the program and the normal fee charged."
Public information available to public of dental office safety
92:30-H-7
"Resolved, that the Academy of General Dentistry believes that any
advertisement of the HIV status of the dentist or any member of the dental
team is misleading to the dental consumer
and be it further
Resolved, that all members and dental personnel are encouraged to work to
educate the public and all patients on the safety of dental procedures and the
precautions taken by dental professionals to safeguard patients' health in the
dental office."
Resource-Based Relative Value Scale
89:53-H-7
"Resolved, that the Academy of General Dentistry opposes use of the
Resource-Based Relative Value Scale as a method of determining payment
for services provided by dentists."
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Rights of employers to provide health care benefits
80:24-H-7
"Resolved, that AGD agrees in principle with the traditional rights of all
employers to provide health care benefits for their employees, and be it
further
Resolved, that AGD continue its dialogue with the ADA to clarify any
proposal to provide dental benefits to federal employees."
School curricula – oral health education
2002:23-H-7
“Resolved, that the Academy of General Dentistry advocates incorporation
of oral health education into primary and secondary school curricula with
measurable outcomes, as a proven and cost effective disease prevention and
universal health promotion program.”
Soft drink consumption/pouring rights contracts
2004:13-H-7
“Resolved, that the Academy of General Dentistry, through its appropriate
agencies, continue to review the supporting data concerning the oral health
effects of the increasing consumption of beverages containing sugars,
carbonation or acidic components. These products are commonly referred
to as “soft drinks,” including but not limited to juice drinks, sports drinks
and soda pop, and be it further
Resolved, that the Academy of General Dentistry encourages its constituents to work with education
officials, pediatric and family practice physicians, dietetic professionals, parent groups, and other
interested parties, to increase the awareness of the importance of maintaining healthy vending
choices in schools, and to encourage the promotion of fluoridated water and beverages of high
nutritional value, and be it further
Resolved, that the Academy of General Dentistry opposes contractual arrangements,
including pouring rights contracts, that influence the consumption patterns that
promote increased access to ‘soft drinks’ for children.”
Supervision, definitions of for dental hygienists and other dental auxiliaries
85:27-H-7
"Resolved, that the Academy of General Dentistry believes that a dental
hygienist or other dental auxiliary, in accordance with their training and
education, and state law, shall, under a dentist's supervision, perform those
aspects of treatment delegated by that dentist; and be it further
Resolved, that the setting in which a dental hygienist or other dental
auxiliary may perform legally designated functions shall be a treatment
facility under the jurisdiction and supervision of a licensed dentist; and be if
further
Resolved, that the AGD shall use the following definitions of 'supervision':
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General Supervision means that the dentist has authorized the
procedures and they are being carried out in accordance with his/her
diagnosis and treatment plan.
Indirect Supervision means that the dentist is in the dental office,
authorizes the procedure and remains in the dental office while the
procedures are being performed by the auxiliary.
Direct Supervision means that the dentist is in the dental office,
personally diagnoses the condition to be treated, personally authorizes
the procedure and before dismissal of the patient, evaluates the
performance of the dental auxiliary.
Personal Supervision means that the dentist is personally operating on
a patient and authorizes the auxiliary to aid his/her treatment by
concurrently performing a supportive procedure."
2008:321-H-7
“Resolved, that the AGD define and incorporate into existing policies the
definition of dental auxiliaries to include midlevel practitioners and all other
individuals who are not licensed dentists, but otherwise provide oral health
care.”
Surgeon General's Report on Oral Health
Implementation plan
2001:26-H-8
“Resolved, that it is the role of the Academy of General Dentistry to
implement the Surgeon General’s Report on Oral Health by:
1.
2.
Expanding the demand for and availability of dental continuing
education opportunities that:
a.
Address the management of the oral health needs of at-risk
toddlers, children, special needs, and geriatric patients.
b.
Expand the knowledge of practicing dentists in the areas of
oral medicine and the relationships between oral health and
general health.
Working with other health care organizations to expand and elevate
the knowledge of health care professionals, policy-makers, and the
public (with an emphasis towards underserved communities) about:
a.
The relationships between oral health and general health.
b.
Oral disease prevention measures including home care,
nutrition, fluoride, sealants, and tobacco cessation.
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c.
3.
Promoting oral health in school curricula.
Advocate the development and implementation of appropriate
proactive measures that will improve access to dental care (such as
student loan forgiveness, tax credits and/or incentives to induce
recent dental school graduates to practice in underserved areas).”
Third party mechanisms
ADA's role in problems with
81:27-H-7
"Resolved, that the AGD recognize the American Dental Association's
appropriate role in communicating with third party payment mechanisms
for the purpose of upholding prepayment standards which have been agreed
upon by the profession, and be it further
Resolved, that all complaints involving third party payment mechanisms
taking more than 30 days to reimburse patients or dentists for dental services
rendered be referred to the ADA so that appropriate dialogue may be
instituted with the third party on behalf of the public and the dental
profession."
Claim contested by dental consultant of
75:30-H-10
"Resolved, that should a patient's claim be contested by the third party's
dental consultant, patient, or the patient's dentist, it shall be submitted to the
local level of organized dentistry's peer review system and the third party,
the patient, and the dentist should agree that the action of the peer review
system is binding."
Considerations in deliberating dental health insurance programs
74:8-H-11
"Resolved, that the Academy of General Dentistry take into consideration
the needs of the public, the various third party pre-payment mechanisms,
and the entire dental profession in deliberating on dental health benefits
programs which might be of concern to the general dentists which compose
its organization."
Consultant of, should make no representation to patient regarding dentist's
service or fee
75:29-H-10
"Resolved, that when a patient's claim is considered for modification,
and/or review, the third party dental consultant should contact the patient's
dentist to discuss the matter fully rather than making any representation to
the patient with respect to the dentist's services or fees."
Diagnostic imaging
94:15-H-7
"Resolved, that the Academy of General Dentistry supports third-party
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reimbursement for all forms of diagnostic imaging determined to be
medically necessary by the treating dentist and supported by appropriate
clinical criteria."
Differentials in levels of reimbursement in
77:13-H-6
"Resolved, that the Academy of General Dentistry is opposed to
differentials in levels of reimbursement in third party programs based on
whether or not a practicing dentist is a 'participating' or 'non-participating'
dentist in such a program, and be it further
Resolved, that this resolution be communicated to the ADA, Delta Dental
Plans, and all of the participating Delta Dental Plans in every state in the
United States."
86:34-H-7
"Resolved, that the AGD is unequivocally opposed to any type of separate
fee schedules for reimbursement to general practitioners and specialists for
the same or similar services; and be it further
Resolved, that AGD policy #76:53-H-11 be rescinded." (Second and Third
Clauses rescinded HOD 2007:301-H-7, see rescinded policies)
Fee Determination
2009:317RS-H-7 “Resolved, that third party payers should not determine fees for
procedures not covered and/or not reimbursed in their policies. And be it
further,
Resolved, that the appropriate AGD agencies be directed to help AGD
constituents develop legislation that will prevent third party payers from
setting fees for non-covered and/or non-reimbursed procedures.”
Fee schedules based on utilization reviews considered arbitrary
2000:25-H-7
“Resolved, that the Academy of General Dentistry believes that any fee
schedule by third party dental benefit administrators or other entities that
separates dentists into different payment levels as determined by
statistically based ‘utilization reviews’ is arbitrary, discriminatory, and not
consistent with appropriate patient care.”
Guidelines for handling members’ problems with
75:33-H-10
"Resolved, that the AGD adopt the following guidelines for handling
communications from members on their problems with third party
programs:
a.
All complaints must be placed in writing and be sufficiently
documented.
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b.
The executive director, in consultation with the Dental Care Council
chairman, shall be charged with the responsibility of corresponding
directly with those carriers that are acting in opposition to policy
previously established by the AGD.
c.
The AGD should seek the help of the American Dental Association on
those complaints involving a violation in ADA policy."
Not to interfere with dentist's diagnosis and treatment
75:32-H-10
"Resolved, that the AGD recognize a third party payment mechanism's
responsibility to determine its liability and extent of dental benefits but is
unalterably opposed to any administrative procedure that interferes with the
attending dentist's diagnosis and treatment plan."
86:33-H-7
"Resolved, that alternative payment systems for all dental care delivery
should not infringe upon the right and responsibility of the licensed
practicing dentist to diagnose and treat patients according to the proper
standard of care."
Overpayment recovery practices
2003:13-H-7
“Resolved, that the Academy of General Dentistry seek and support efforts
opposing third party overpayment recovery practices, except as
contractually obligated, when the overpayment was the result of a mistake
made by the insurer and accepted by the dentist in good faith without prior
or reasonable knowledge of the error, and be it further
Resolved, that the Academy of General Dentistry seek and support efforts to
prevent third party payers from withholding fully assigned benefits to a
dentist when an incorrect payment has been made to the dentist on behalf of
the subscriber with the same third party payer.”
Participation should not be contingent upon participation in government
regulated programs
97:30-H-8
“Resolved, that retention of a license to practice dentistry and participation
in third party plans should not be contingent upon participation in
government regulated programs.”
Reduction/denial of dental benefits must be signed by licensed dentist
2000:26-H-7
“Resolved, that the Academy of General Dentistry believes that any third
party reduction or denial of dental benefits on the basis of ‘not medically
necessary or appropriate’ must be made on an individual basis and signed
by a dentist licensed in the state or province in which the procedures are
being performed, and be it further
Resolved, that the Academy of General Dentistry believes that any third
party reduction of dental benefits on the basis of ‘least expensive alternative
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treatment’ be made on an individual basis and signed by a dentist licensed in
the state or province in which the procedures are being performed, and be it
further
Resolved, that the Academy of General Dentistry believes that any review
of clinical records for the purpose of reducing or denying dental benefits
must be made on an individual basis and signed by a dentist licensed in the
state or province in which the procedures are being performed.”
Regulated by law or state governmental agency
85:23-H-7
"Resolved, that all third-party payment mechanisms be regulated by law or
through the appropriate state governmental agency to ensure fiscal
responsibility and protection of the interests of the public."
Tissue biopsy
2006:25-H-8
“Resolved, that it is the position of the AGD that the decision whether or
not to biopsy oral tissues lies within the purview of the treating dentist.”
TMD policy statement
86:29-H-7
"Resolved, that the Academy of General Dentistry support legislation and
rules and regulations that would require third-party mechanisms selling
dental benefits programs based on UCR in a state, to use data that is not
more than six months old on the date of filing, and so state this date in
published material to users and prospective users of these programs; and be
it further
Resolved, that the AGD communicate the problems being addressed by this
resolution to the ADA's Council on Dental Benefit Programs to seek a
viable solution; and be it further
Resolved, that the AGD's Dental Practice Council assess solutions being
offered by the ADA to see if further action by the AGD is needed."
89:55-H-7
"Resolved, that the Academy of General Dentistry's TMD Policy is:
1.
The existence of TM orders is undeniable and these disorders can be
treated by the general dentist.
2.
There are a variety of viable diagnostic and treatment modalities for
TM disorders, as there are in the treatment of physiological disorders,
back problems, and many other medical maladies.
3.
Like any disorder or disease, the indication for TMD treatment is a
doctor/patient decision. The criteria for this decision is both subjective
and objective.
4.
It is not possible to list all the effective (and thus reimbursable) TMD
procedures. It is the application of clinical judgment which determines
the appropriate treatment modality.
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and be it further
Resolved, that the Academy of General Dentistry support the concept that
comprehensive policies or certificates of health, medical, hospitalization, or
accident and sickness insurance should provide reimbursement for the
diagnosis and therapeutic treatment of temporomandibular
dysfunction/myofascial pain dysfunction and associated diseases and
dysfunctions and that benefit coverage be the same as that for treatment of
any other joint in the body and be applicable if the treatment is administered
or prescribed by a physician or a dentist, and be it further
Resolved, that Resolution 88:53-H-7 be rescinded."
TMJ
Medical care contracts should not discriminate against dentists
88:52-H-7
"Resolved, that in cases where dentists provide their expertise in treatment
of temporo-mandibular joint dysfunction and cranio-mandibular disorders,
medical care contracts should not discriminate in benefit payments based on
the professional degree of the provider."
Medical care contracts should provide mandatory coverage for treatment of
*88:53-H-7
RESCINDED
Tooth numbering system
81:28-H-7
"Resolved, that the Academy of General Dentistry endorses the universal (1
to 32/a to t) tooth numbering system adopted by the ADA and encourage its
immediate implementation through the American Dental Association and
the American Dental Education Association and other segments of the
dental profession."
Untoward responses to products, materials, and medications
98:23-H-7
“Resolved, that the Academy of General Dentistry encourage its members
to be aware of possible untoward responses to products, materials, and/or
medications used in the dental office, and that the use of these products,
materials and/or medications will be up to the discretion of the treating
provider.”
Workforce, adequacy of present dental workforce
2002:26-H-7
“Resolved, that the Academy of General Dentistry adopt the following
statement relative to the adequacy of the dentist workforce in 2002:
The dentist workforce in the United States is sufficient to meet the needs of
the public demand for dental services. Geographic imbalances exist in
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localized areas due to a variety of factors. Where these imbalances result in
shortages, the affected regions must be examined and addressed
individually for appropriate solutions. The development of a responsive,
competent, diverse, and “elastic” workforce should address potential
increases in demand for dental services.”
Work force issues, position statement
2005:3-H-07
“Resolved, that the Academy of General Dentistry’s position in response to
work force issues is:
 AGD believes that access to oral health care is an issue that needs to
be addressed throughout the profession.
 AGD believes that general and pediatric dentists, working in concert
with the dental team, are the gatekeepers of oral health.

AGD believes that general dentists are uniquely qualified to help
provide and maintain the optimal standard of care.”
Dental Consultant
Coalition to restore deduction for student loan interest
93:29-H-7
"Resolved, that the Academy of General Dentistry support the efforts of the
Student Loan Interest Deduction Restoration Coalition to restore the
deduction of interest paid on student loans."
Must be a licensed dentist
75:27-H-10
"Resolved, that the AGD recognizes that a dental consultant must be a duly
licensed dentist within said state."
Dental Education
Deduction of interest paid on student loans
2008:301S-H-7
“Resolved, that the Academy of General Dentistry support efforts to restore
the full deduction of interest paid on student loans regardless of income.”
Dental schools, support state funding for
80:22-H-7
"Resolved, that AGD recognizes the need for adequate funding to enable
dental schools to provide a proper dental education, but at the same time,
AGD encourages dental schools to seek state and/or private support in lieu
of federal capitation funding."
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81:37-H-7
"Resolved, that AGD support the concept of using state funds to assist in
maintaining and operating the physical facilities of existing dental schools."
Formal academic process leading to a degree or certificate
81:41-H-7
"Resolved, that AGD endorse the concept of a formal academic process of
structured, sequential continued or post-doctoral education, earned through
universities or academically accredited teaching institutions over an
extended amount of time, which lead to a degree or a certificate."
Four-year curriculum, support of
78:27-H-6
"Resolved, that the AGD expresses its concern with the dilution and
shortening of dental school programs for purpose such as the receiving of
federal capitation grants, and be it further
Resolved, that the AGD supports a minimum of a four-year approved
curriculum to achieve a dental degree, and be it further
Resolved, that the AGD send a letter to all of the existing dental schools
expressing our support of those dental schools which have relinquished their
three-year programs in favor of pursuing quality four-year dental education
programs."
Liaison consortium
98:31-H-7
“Resolved, that the Academy of General Dentistry convene a ‘Liaison
Consortium’ to consist of two representatives from the Academy of General
Dentistry (AGD), two representatives from the American Dental Education
Association (ADEA), two representatives from the American Association
of Hospital Dentists (AAHD), one representative each from the Federal
Services Board, the American Board of General Dentistry, and the
Veteran’s Administration Residency Programs to meet twice each year
beginning in April of 1999, and be it further
Resolved, that the mission of the consortium will be to coordinate the
representation of predoctoral and postdoctoral general dentistry educators by
identifying their needs, facilitating communication, and promoting resource
sharing among the involved organizations.”
Licensure
82:34-H-7
"Resolved, that in states where laws are already in effect which mandate
involvement in continuing education as a condition of dental licensure
and/or dental license renewal, AGD's constituent AGD in that state's
jurisdiction work with the state board of dental examiners and other
appropriate dental agencies to protect the interests of AGD members in that
state as mechanisms for enforcement and administration of that requirement
are developed and implemented, and be it further
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Resolved, that Resolution #76-51, as passed by the 1976 House of
Delegates, be rescinded."
96:46-H-7
"Resolved, that the Academy of General Dentistry encourage its constituent
academies to work with state or provincial boards of dental examiners, state
legislatures, or regulatory bodies in implementing the following provisions
for mandatory continuing dental education when legislation or regulations
are under consideration in their states or provinces:
1.
acceptance of program providers approved by the AGD of General
Dentistry, ADA Continuing Dental Education Recognition Program
and the AGD's intrastate approval program;
2.
the acceptability of self-instruction programming;
3.
acceptance of the AGD member printout as one form of
documentation of the requirement;
4.
acceptance of courses relative to the access and delivery of dental
care."
Dental Laboratory Techniques
76:40-H-11
"Resolved, that the Academy of General Dentistry urge the American
Dental Association to, in turn, influence the schools of dentistry to provide
significant instruction in dental laboratory technology for dental students so
that dental school graduates will have the ability to adequately supervise the
laboratory technicians, and be it further
Resolved, that the Academy of General Dentistry urge the American Dental
Association to, in turn, influence the schools of dentistry to institute
programs of instruction to train dental laboratory technicians at the college
and vocational school level, and be it further
Resolved, that, with passage of this resolution, Resolution 75-61 as passed
by the 1975 House of Delegates, be rescinded."
Dental Materials
79:30-H-6
"Resolved, that the AGD recognizes the need to give the American Dental
Association's Council on Dental Materials and Devices appropriate input
from general dentists, and be it further
Resolved, that the AGD recognizes the opportunity given to its president in
the Bylaws to appoint an appropriate representative when it is appropriate
for him to do so, and be it further
Resolved, that the AGD's representative to the American National Standards
Committee MD156 for Dental Materials and Devices be named as a
consultant to the AGD's Dental Practice Council, if he is not already a
member, and be it further
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Resolved, that all problems concerning dental materials and devices be
considered under the purview of the AGD Dental Practice Council."
79:31-H-6
"Resolved, that attendance at MD 156 Committee meetings by a
representative of the Academy of General Dentistry be included in the
Dental Practice Council's budget, on an annual basis."
Purchasing decisions
82:31-H-7
"Resolved, that the Academy of General Dentistry recognizes the problem
of providing the general practitioner with meaningful information upon
which to base purchasing decisions, and be it further
Resolved, that the following strategies be implemented in order to
accomplish this purpose:
1.
Maintain an AGD representative on ANSI MD 156.
2.
Recommend through the Dental Care Council chairman members to
participate on ANSI Subcommittees.
3.
Relay to the ADA AGD's concerns with regard to having the
practicing dentist more informed in order to make proper purchasing
decisions.
4.
Identify which products should be evaluated.
5.
Relay ANSI information to the AGD Foundation Product Comparison
Advisory Board.
6.
Start Product Comparison Program through AGD Foundation.
7.
Publish results of product comparison program in our Journal.
8.
Obtain feedback from our membership on which products should be
evaluated.
9.
Appoint subcommittee of Dental Care Council to facilitate dental
material and device deliberations for the Council."
Dental Practices
Open elections and nominations for officers
78:23-H-6
"Resolved, that all dental service corporations be requested to have open
elections and nominations for officers and members of the Board involving
all of its participating dentists so as to give the participating dentists
representation in matters relating to improvement of patient services and
maintaining high professional standards, and be it further
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Resolved, that this resolution be conveyed to the ADA House of Delegates
for implementation."
To be owned and operated by licensed dentists
86:32-H-7
2009:300-H-7
AMENDED HOD 2009
“Resolved, that policy 86:32-H-7 be amended so that it reads:”
86:32-H-7 “Resolved, that the AGD recognize that the public is best served
when dental practices (those traditional fee for service private
practices or any alternative compensation system of practice) are
owned and operated by dentists licensed in the state or province
of such ownership or operation, and be it further
Resolved, that the AGD supports the inclusion of language in
state dental practice acts that would prohibit a party or parties not
licensed to practice dentistry from becoming involved in the
ownership or control of dental practices with an exception
allowing for the non-dentist survivor or designee of a deceased
dentist to retain ownership of the dental practice in order to
facilitate an orderly transfer of patient records to a new dentist
owner or licensed dental practice with ownership to remain in
effect until an orderly transfer can occur or a two year period
from the death of the original dentist owner.”
Dental Students
Financial assistance to, that restricts choice of geographical location of practice
76:50-H-11
"Resolved, that the AGD oppose any form of federal assistance to dental
schools or dental students that restricts the freedom of graduates of dental
schools to voluntarily choose the type or the geographical location of their
practices, as long as they are able to meet the appropriate state licensing
requirements."
Loan program for
81:23-H-7
"Resolved, that AGD recognize the need for the dental profession to offer
input into a fair and equitable loan program for dental students, supported
by both private and public funds."
81:36-H-7
"Resolved, that AGD recognize the need to have the federal government
involved in providing loans to dental students with the provision that all
such funds be paid back with appropriate interest."
Recruiting highly qualified students
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87:56-H-7
"Resolved that the AGD urge its constituent Academies to continue their
involvement with dental schools and alumni associations in recruiting
highly qualified students for dental schools."
Requiring dental students to repay government capitation loans made to schools
*75:37-H-10
RESCINDED
Denturism
85:24-H-7
"Resolved, that in the interest of the health of the public, the Academy of
General Dentistry supports the need of the dentists to be appropriately
involved in all dental and oral prosthetic care rendered directly to patients,
and as such, opposes the denturism movement."
Direct Reimbursement
Definition of
90:56-H-7
"Resolved, that 'direct reimbursement' be defined as follows:
'Direct reimbursement is a self-funded program in which the individual is
reimbursed based on a percentage of dollars spent for dental care provided,
and which allows beneficiaries to seek treatment from the dentist of their
choice.'"
Promotion of
85:28-H-7
"Resolved, that the Academy of General Dentistry continue its support of
the American Dental Association's efforts and activities to promote direct
reimbursement throughout the country."
97:27-H-8
“Resolved, that the Academy of General Dentistry is in support of and
offers encouragement to the ADA in its efforts to promote direct
reimbursement.”
Dues
Assessment
81:48-H-7
"Resolved, that the Board include an enumeration of any portion of the
membership to be suggested for exemption from a future assessment along
with its complete rationale for any assessment to be considered in the future
by this House of Delegates."
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2005:13H-H-7
Resolved, that the Academy of General Dentistry recommends that dentists
receive training on the recognition and evaluation for signs and symptoms
consistent with abuse and/or neglect.
Enteral Conscious Sedation
2006:1-H-8
“Resolved, that the AGD adopts as policy, the White Paper on Enteral
Conscious Sedation.”
Federal Services
Benefits for military personnel and their dependents
81:38-H-7
"Resolved, that the AGD support the concept of enhancing the benefits
offered to individuals serving in the military by providing dental services
for their dependents, and be it further
Resolved, that these dental services shall be provided by the private sector
where possible, and be it further
Resolved, that the AGD work to have provisions under which these services
are to be provided conform to AGD policy."
Salary reimbursement for military dentists
81:25-H-7
"Resolved, that AGD recognize that factors such as the following items
should be taken into consideration in the salary reimbursement for federal
service dentists:
o
o
o
o
o
o
91:50-H-7
the amount of education acquired by the dentist
the proficiency of the dentist
the level of experience of the dentist and the individual's ability to
handle the more complex dental procedures in a competent manner
status, rank, or duties within the group
tenure
the cost of living in one geographical area as opposed to another."
"Resolved, that the salaries for physicians and dentists in the Federal
Services should be determined by the following factors:
1.
The scope of responsibility which may be determined by rank, title,
etc.
2.
The degree of education which may include specialty training,
general practice residencies, advanced educational programs in
general dentistry, passage of a certifying board, etc.
3.
A relationship with the remuneration generally earned by that
profession within the practicing civilian sector.
4.
Length of service."
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Special pay for uniformed services
93:31-H-7
"Resolved, that the Academy of General Dentistry support the upgrading of
special pay for dentists in the federal uniformed services, and that this
position be properly communicated to the American Dental Association."
Fees
Adjusted for complying with governmental regulations
92:35-H-7
"Resolved, that the Academy of General Dentistry recommends that
dentists may incorporate into their normal overhead the cost of complying
with OSHA, CDC and other government regulations, and be it further
Resolved, that dentists may charge a separate fee or adjust current fees to
cover these costs."
General Dentist
Continued competency
94:24-H-7
"Resolved, that assuring the public of the dental profession's continued
competency is best addressed by appropriate continuing dental education,
effective peer review, and the proper enforcement of the dental practice acts
by the state and provincial boards of dental examiners, and be it further
Resolved, that the AGD of General Dentistry continue to express this
position by letter to members of the American Association of Dental
Examiners Continued Competency Committee and the American
Association of Dental Examiners Executive Council before the final
presentation of the Continued Competency report, and be it further
Resolved, that the Academy of General Dentistry express this position by
letter to the American Dental Association, the American Dental Education
Association and all other individuals and organizations that would be
affected by or have influence on this issue."
Creed of
84:17-H-7
"Resolved, that the Academy of General Dentistry establish a creed for the
purpose of more closely identifying the organization with a philosophy and
code of conduct, and be it further
Resolved, that the following five statements be adopted as the AGD creed:
1.
To educate myself to perform with greater ability.
2.
To provide and promote the best treatment for my patients.
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3.
To treat my patients with continued dignity and empathy.
4.
To share my knowledge with my patients and my profession.
5.
To maintain my integrity and professionalism.
And be it further
Resolved that if feasible, the AGD creed be included on the back of the
AGD membership cards and used in such other ways determined to be
appropriate."
Coordinate and manage dental health
82:22-H-7
"Resolved, that the AGD recognizes that it is in the best interest of the
public for the general dentist to coordinate and manage the oral health care
needs of all patients."
Definition of
*83:17-H-7
RESCINDED
*82:33-H-7
RESCINDED
84:16-H-7
RESCINDED HOD 2007
2007:303-H-6
AMENDED HOD 2008
2008:319S-H-7
2009:310-H-7
AMENDED HOD 2009
“Resolved, that the AGD amend policy 2008:319S-H-7.
“Resolved, that Policy 2007:303-H-7 be amended so that it reads:
2007:303-H-7 “Resolved, that policies 82:33-H-7 and 84:16-H-7 be
rescinded, and be it further
Resolved, that AGD defines a general dentist as 'An individual who has
successfully completed formal dental training leading to a DDS, DMD, or
comparable degree which qualifies that individual to be a dentist and to
accept the professional responsibility for the diagnosis, treatment,
management, and overall coordination of services that meets patients' oral
health needs, and who has not announced a limitation of practice to any of
the specialty areas recognized by the American Dental Association,’ and be
it further
Resolved, that the AGD defines 'primary dental care provider' as 'the
general or pediatric dentist who accepts the professional responsibility for
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the treatment of the patient and/or the management and coordination of
services to meet the patient's oral health needs, consistent with the ADA
Principles of Ethics and Code of Professional Conduct.”
Parity with physicians in all remuneration
75:39-H-10
RESCINDED HOD 2008
2008:302-H-7
“Resolved, that policy 75:39-H-10 is rescinded.”
Primary dental care provider, defined
95:8-H-7
"Resolved, that the AGD define 'primary dental care provider' as 'the
general or pediatric dentist who accepts the professional responsibility for
the treatment of the patient and/or the management and coordination of
services to meet the patient's oral health needs, consistent with the ADA
Principles of Ethics and Code of Professional Conduct,' and be it further
Resolved, that policy 82:33-H-7 be rescinded."
Primary entry point into dental care system
75:38-H-10
"Resolved, that the AGD endorse the concept of having the patient's entry
level into the dental health care delivery system be through the general
practitioner, and be it further
Resolved, that it be the general practitioner's prerogative to determine when
and if a patient should be referred to another source for his dental treatment,
and be it further
82:21-H-7
"Resolved, that the AGD recognizes that it is in the best interest of the
public for the general dentist to be the primary entry point into the dental
care delivery system."
Resolved, that the AGD advocate this position in programs involving federal
and state governments as well as insurance companies so that optimal dental
health care will be more readily available to larger segments of the public at
less cost."
General Practice Residency Program
79:32-H-6
"Resolved, that the AGD support general practice residency programs, and
be it further
Resolved, that the AGD recommend that a significant portion of the content
of all general practice residency programs be devoted to but not limited to
experience in a hospital environment, and be it further
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Resolved, that the AGD recognizes the concept of and the need for the
general dentistry residency."
Commission on accreditation urged to require that directors of GPR's be general dentists
80:33-H-7
"Resolved, that the ADA Commission on Dental Accreditation be urged to
require that, in the future, the directors of general practice residency
programs and advanced educational programs in general dentistry be
well-qualified general dentists."
Geriatric Care
76:54-H-11
"Resolved, that the AGD recognizes the importance of dental care for the
geriatric patient, and recommends that constituent academies through state
dental societies institute whatever means necessary to inform the geriatric
patient of the importance of regular dental care, and to aid in the providing
of that care to economically disadvantaged geriatric patients."
Health Maintenance Organizations (HMO’s)
Providing funds for HMOs
75:40-H-10
2008:303-H-7
RESCINDED HOD 2008
"Resolved, that policy 75:40-H-10 is rescinded.”
Health Planning
Organized dentistry to provide input for
81:39-H-7
"Resolved, that the AGD recognize the need for appropriate health
planning, and be it further
Resolved, that the AGD support the concept of organized dentistry having
input into health planning, and be it further
Resolved, that the AGD support the concept of using local funds for health
planning, and, when necessary, state and federal funds."
Support to repeal Health Planning Act
*81:22-H-7
RESCINDED HOD 7/2000
HIV
HIV-infected patients, policy on
"Resolved, that the AGD regards HIV-infected patients as medically
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88:50-H-7
compromised individuals with an infectious disease who deserve the most
considerate and scientifically sound dental care available and be it further
CLAUSE
RESCINDED
HOD 7/99
Resolved, that the AGD vigorously opposes state and/or federal laws and
regulations that would classify persons with infectious diseases as
handicapped, and be it further
Resolved, that the AGD opposes dental care discrimination against any
individual, including those with infectious diseases."
HIV testing of dental personnel
*88:49-H-7
RESCINDED
Statement on disclosure and infection control
91:51-H-7
REVISED
HOD 7/99
"Resolved, that the Academy of General Dentistry strongly supports the
validity and use of universal precautions and appropriate sterilization
procedures as techniques that greatly reduce the risk of transmission of the
Hepatitis (HBV) and Human Immunodeficiency (HIV) viruses between
health care workers and patients, and be it further
Resolved, that the AGD supports voluntary testing of health care providers
for HBV and HIV in the appropriate settings, but opposes mandatory testing
because it is impractical and ultimately ineffective as a preventive measure,
and be it further
Resolved, that dentists and other health care personnel who believe they are
infected with HIV or HBV should obtain medical advice and, if found to be
infected, should act upon that advice and submit to regular medical
supervision, and be it further
Resolved, that the AGD work to educate the public on the safety of dental
procedures and the techniques used by dental professionals to safeguard
patients' health, and be it further
Resolved, that policy #88:49-H-7 be rescinded."
Hospital Dentistry Privileges
*85:22-H-7
RESCINDED
Implants
*75:41-H-10
RESCINDED
*75:42-H-10
RESCINDED
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91:47-H-7
"Resolved, that the AGD House of Delegates agrees that oral implant
therapy can be an acceptable mode of clinical treatment when indicated,
and be it further
Resolved, that policy 75:41-H-10 be rescinded."
*92:31-H-7
RESCINDED HOD 7/96
96:53-H-7
"Resolved, that as an adjunct to the AGD's existing policy with regard to
the consideration of implant dentistry as a specialty, that the following
principles be adopted:
1.
The AGD actively supports the policy that all qualified dentists be
permitted to perform all aspects of implant dentistry including
placement and restoration.
2.
The AGD believes that it is in the public's best interest that oral
implantology not be limited to one discipline of dentistry.
3.
The AGD opposes the implication that specialists performing oral
implants are also specialists in implantology
4.
The AGD opposes any marketing efforts that imply any provider of
implants is a qualified oral implantology specialist
and be it further,
Resolved, that Policy 92:38-H-7 be rescinded."
Pre-doctoral education
92:32-H-7
"Resolved, that the AGD support pre-doctoral education in the diagnosis,
placement and restoration of oral implants in the curricula of all dental
schools, and be it further
Resolved, that this resolution be transmitted to the ADA House of Delegates
and to the American Dental Education Association."
Infection Control Measures Urged
*87:64-H-7
RESCINDED HOD 7/99
Infectious Waste
State and government regulation
90:55-H-7
"Resolved, that the AGD recognize that state law and government
regulation is determining the definition and handling of infectious waste,
and be it further
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Resolved, that when evaluating the merit of such regulations, the AGD
primarily will be concerned about the safety of the public, and also will
insist that the
regulations be based on scientific validity with appropriate consideration
given to cost effectiveness."
Insurance, Malpractice
84:24-H-7
"Resolved, that the Academy of General Dentistry continue to support the
American Dental Association's three-classification system for malpractice
insurance until such time as evidence has been presented to indicate that
there is merit in going to another system."
Legislation
Access to dental care
Incentives for dentists to practice in underserved areas
2001:29-H-8
“Resolved, that the Academy of General Dentistry believes that in order to
encourage dentists to practice in underserved areas, the following must
occur:
a.
The period over which student loans are forgiven must be extended
to 10 years, without a tax liability for the amount forgiven in any
year.
b.
Tax credits must be provided for establishing a dental practice in
said areas.
c.
Scholarships must be offered to dental students in exchange for
serving in said areas.
d.
Federal loan guarantees must be provided for the purchase of dental
equipment and materials.
e.
Appropriations for funding an increase in the number of dentists
serving in the National Health Service Corps must be enacted.
f.
Active recruitment of applicants for dental schools from underserved
areas.”
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Legislative agenda for providing
2001:28-H-8
REVISED
HOD 7/2002
“Resolved, that the Academy of General Dentistry believes that any effort to get the
necessary personnel to improve access to and utilization of dental care for indigent
populations will be multifactoral and complex, and includes but is not limited to the
following items (understanding that these items are not prioritized and will vary from state
to state):
a.
Take steps to facilitate effective compliance with governmentfunded dental care programs to achieve optimum oral health
outcomes for indigent populations.
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
x.
b.
raise fees to at least the 75th percentile of fees which
dentists currently charge
eliminate extraneous paperwork
simplify Medicaid rules
mandate prompt reimbursement
educate Medicaid officials regarding the unique nature of
dentistry
provide block grants to states from the federal government
for innovative programs
require mandatory annual dental examinations for children
entering school (analogous to immunizations) to determine
their oral health status
encourage education of patients in proper oral hygiene and
in the importance of keeping scheduled appointments
utilize case management to ensure that the patients are
brought to the dental office
increase general dentists’ understanding of the benefits of
treating the indigent
Establish Alternative Oral Health Care Delivery Service Units
i.
ii.
iii.
provide oral health care, education, and preventive
programs in schools
arrange for transportation to and from the centers
solicit volunteer participation from the private sector to
staff the centers
c.
Encourage private organizations such as Donated Dental Services,
fraternal organizations, and religious groups to establish and
provide service
d.
Provide Mobile and Portable Dental Units to service the
underserved and indigent of all age groups
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e.
Identify educational resources for dentists on how to provide care
to pediatric and special needs patients and increase AGD dentist
participation
f.
Provide information to dentists and their staffs on cultural diversity
issues which will help them reduce or eliminate barriers to clear
communication and enhance understanding of treatment and
treatment options
g.
Pursue development of a comprehensive oral health education
component for public schools’ health curriculum in addition to
providing editorial and consultative services to publishers of
primary and secondary school textbooks
h.
Increase supply of dental assistants and dental hygienists
i.
Strengthen alliances with ADEA and other professional
organizations
j.
Expand the role that retired dentists can play in providing service
to the indigent.”
White Paper on Increasing Access to and Utilization of Oral Health Care
Services
2008:323-H-7
“Resolved, that the AGD adopt the White Paper on Increasing Access to
and Utilization of Oral Health Care Services.”
AGD opposes limiting political or PAC contributions
87:53-H-7
"Resolved, that the Academy of General Dentistry opposes federal
legislation reducing limits on political action committee contributions to
candidates for elected office."
Air Force Assistant Surgeon General, Rank of
98:25-H-7
2008:312-H-7
RESCINDED HOD 2008
“Resolved, that policy 98:25-H-7 be rescinded.”
Cash method of accounting, not accrual
98:26-H-7
“Resolved, that the Academy of General Dentistry support the use of the
cash method of accounting, and not the accrual method, where preferred, by
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dentists engaged in the private practice of dentistry, and be it further
Resolved, that the Academy of General Dentistry communicate this
position, when necessary, to legislative and regulatory entities.”
Community Health Centers
2003:15A-H-7
“Resolved, that the AGD recognizes that Community Health Centers can be
a component in the effort to increase access to oral health care if the
Community Health Center Board partners with local dental societies in
order to contract with locally practicing dentists and more adequately
identifies and reaches underserved and indigent (defined as 150% of the
Federal Poverty Level) populations, and be it further
Resolved, that appropriate legislative activity be pursued to ensure that
Community Health Centers are properly funded and function in the manner
for which they were intended.”
Deduction for member dues
87:55-H-7
"Resolved, that the AGD support legislation and seek coalitions with other
professional organizations that will allow salaried professionals to fully
deduct dues to professional organizations without having to exceed the 2%
of adjusted gross income now required for deduction of miscellaneous tax
deductions."
Dental Lab Disclosure
2008:320RS1-H-7
"Resolved, that the Academy of General Dentistry support legislation
that requires dental labs to provide written disclosure to dentists the place
of fabrication and the specific composition of all materials used in the
fabrication of dental restorations and appliances.”
Federal Trade Commission
88:51-H-7
"Resolved, that the Academy of General Dentistry has a high priority in
urging every member of Congress to join in the adoption of legislation that
would restrict the Federal Trade Commission from intervening in
state-regulated professions."
FTC's efforts to pre-empt state laws re corporate ownership
86:31-H-7
AMENDED 2008:309-H-7
2008:309-H-7
“Resolved, that policy 86:31-H-7 be amended so that it reads:
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"Resolved, that in the interest of safeguarding patient care and freedom of
choice, the AGD opposes any efforts by the Federal Trade Commission
and any other agencies to preempt state laws that prohibit non-dentist
owned corporate dental practices, and be it further
Resolved, that the AGD supports any efforts to challenge the Federal Trade
Commission's and any other agency's statutory authority to preempt state
laws regarding non-professional, non-provider ownership of health care
practices."
General Practitioner's role as gatekeeper for oral health
2008:316-H-7
“Resolved, that the AGD as an organization of general dentists make every
effort to inform policy makers of the potential effect increased
specialization of dentists will have on the fragmentation of dentistry,
especially on rural communities’ access to oral health care.”
Government relations manager
*85:29-H-7
RESCINDED
HOD 7/99
"Resolved, that the House of Delegates endorses the action of the Board of
Trustees in its efforts to maintain and strengthen the general practitioners'
representation in Washington by having the AGD's Executive Director hire
a Government Relations Manager, to the staff of the AGD, to be housed in
the same building as the Washington office of the American Dental
Association, on a pilot basis."
Government subsidized health care programs
78:21-H-6
"Resolved, that AGD oppose all programs that allow government
subsidized health care delivery systems to compete unfairly with the private
practice delivery system, and be it further
Resolved, that the Council on Legislation direct their efforts in concert with
the appropriate councils of the ADA and their constituent legislative councils
to gather and disseminate all information which deals with this issue to the
appropriate leadership at the national and state levels, and be it further
Resolved, that the leadership in the profession at national and state levels
make every effort to upgrade the information deficit of federal and state
legislatures so that they may be fully informed."
Guidelines for dealing with state legislation
89:54-H-7
"Resolved, that the Academy of General Dentistry use the following
guidelines in dealing with members requesting AGD action on legislation
being proposed in their state:
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1.
Members have the right to know existing policies.
2.
The AGD will not intervene in the legislative affairs of a state or
province without the written request of the constituent AGD.
3.
Members requesting support from the AGD for a legislative position
will be asked to work through their constituent.
4.
Constituent secretaries/executive directors and Trustees will be
provided with copies of AGD correspondence with their members
regarding concerns about legislative issues being considered."
Indigent population, AGD as a voice for the
2003:15B-H-7
AMENDED 2008:310RS-H-7
2008:310RS-H-7
“Resolved, that policy 2003:15B-H-7 be amended so that it reads:
“Resolved, that the AGD continue to be an advocate for the oral health
of the general population, including but not limited to the underserved.
Language interpretation at provider’s expense
2001:31-H-8
“Resolved, that the Academy of General Dentistry is opposed to any
federal, state or local government mandate that would require a dentist or
other health care provider to supply, at the provider’s expense, language
interpretation for patients who do not speak English or who have limited
proficiency with the English language.”
Legislative or regulatory mandates with inadequate scientific basis
2000:30-H-7
“Resolved, that the Academy of General Dentistry oppose any legislative or
regulatory mandate affecting the practice of dentistry which is based on
principles that do not have adequate scientific basis as determined by the
AGD.”
Link between periodontal disease and low birth-weight babies
2003:14-H-7
“Resolved, that the Academy of General Dentistry supports legislation that
seeks to increase accurate and up-to-date professional and public awareness
of the link between periodontal disease in pregnant women and pre-term,
low-birth weight babies and the maternal transmission of caries.”
Luken Lee Amendment, endorsement of ADA's position
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*82:29-H-7
RESCINDED HOD 7/99
Managed care, AGD’s legislative priorities regarding
97:29-H-8
“Resolved, that the AGD’s legislative priorities with regard to dental
managed care encompass the following:
Patients will have the choice to select a plan with a point-of-service
option, with reasonable cost-sharing requirements in premiums and
per-service costs provided that those costs are not excessive.
Patients in a plan will be allowed to select their dentist, and change
that selection as the patient feels is necessary.
The plan shall provide access to an adequate mix and number of
dentists, including both general dentists and specialists, to ensure
access to those services covered by the plan C including patients in
rural and dentally under-served areas.
The plan shall allow patients with special needs to be referred to
appropriate providers including specialists.
The plan shall provide an appropriate appeals and grievance
procedure that allows for timely responses to patient and/or provider
complaints.
The plan shall provide a dentist, licensed to practice in that state or
province where the services are provided, to be responsible for
dental treatment policies, protocols, and quality assurance activities.
The plan shall define and disclose limitations on coverage of
experimental treatments and provide timely written justification for
denial of such treatment to patients.
The plan shall not discriminate in participation, reimbursement, or
indemnification against any dentist solely on the basis of his/her
license.
The plan shall not prohibit or limit a dentist or other health
professional from engaging in communications regarding the
patient’s health status, health care, treatment options, or utilization
review requirements.
The plan shall not provide any financial incentives to dentists, other
health professionals, or reviewers to deny or limit care.
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The plan shall provide dentists with reasonable notice of termination
and allow the dentist to appeal such a decision and take corrective
action if necessary.
The plan shall assume any liability resulting from the plan’s denying
or restricting treatment or referral to specialists.”
Mandating national licensure
76:49-H-11
2008:311-H-7
RESCINDED HOD 2008
“Resolved, that policy 76:49-H-11 is rescinded.
Mandating preferred provider organizations
84:25-H-7
"Resolved, that the Academy of General Dentistry oppose any federal
legislation for the purpose of mandating preferred provider organizations,
or pre-empting state laws that regulate preferred provider organizations."
Military dentists, special pay and incentives for
2001:30-H-8
“Resolved, that the Academy of General Dentistry request immediate action
to stem the exodus of current military dental officers and assure a
continuing supply of quality accessions, and be it further
Resolved, that the AGD favor increasing additional special pay, establishing
incentive pay for dentists, and increasing Health Professions Scholarship
Program (HPSP) scholarship funding.”
National Practitioner Data Bank
90:57-H-7
"Resolved, that the Academy of General Dentistry work with the ADA to
urge Congress and the Department of Health and Human Services to amend
the National Practitioner Data Bank so that it will include only information
on suspension of license, revocation of license or loss of hospital privileges
for disciplinary reasons, and be it further
Resolved, that the following resolution adopted by the 1989 AGD House of
Delegates be rescinded:
1989-40R.
'Resolved, that the Academy of General Dentistry urge
Congress and the Department of Health and Human
Services, both directly and through the American Dental
Association, to abandon the National Practitioner Data
Bank because of its potential for abuse, its high cost of
implementation, its impact on peer review and its lack of
regard to the overall quality and total volume of care
provided.'"
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NIDCR
2003:18-H-7
“Resolved, that the Academy of General Dentistry supports the continued
existence and current structure and mission of the National Institute of
Dental and Craniofacial Research, and be it further
Resolved, that the AGD will take appropriate steps to lobby in support of
NIDCR.”
Nitrous oxide inhalation sedation
94:18-H-7
“Resolved, that the Academy of General Dentistry supports the use of
scavenging equipment for nitrous oxide, and be it further
Resolved, that any additional regulation of nitrous oxide be based on valid
scientific documentation.”
Prohibiting latex use without documented scientific evidence
98:22-H-7
“Resolved, that the Academy of General Dentistry be directed to oppose
any legislation or regulation that is not based on documented scientific
evidence of significant general risk to dental patients or workers which
would prohibit the use of latex or latex-containing products in the dental
office.”
Protect dental insurance as a fringe benefit
81:24-H-7
AMENDED 2008:306-H-7
2008:306-H-7
“Resolved, that policy 81:24-H-7 be amended so that it reads:
"Resolved, that the AGD work to ensure that legislation would not
adversely affect an employer's decision to provide dental insurance.”
83:24-H-7
2008:307R-H-7
AMENDED 2008:307R-H-7
“Resolved, that policy 83:24-H-7 be amended so that it reads:
“Resolved, that the AGD resist efforts being made by third party dental
benefits programs to prohibit payment based on the specific technique used
by the dentist to render treatment for the patient.”
Public disclosure of information in National Practitioner Data Bank
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2000:27-H-7
“Resolved, that the AGD oppose public disclosure of National Practitioner
Data Bank information because it has the potential to provide misleading
information about physician and dentist competency.”
Public Health Service Surgeon General
96:55-H-7
"Resolved, that the Academy of General Dentistry recommends and
supports continued and ongoing Congressional funding of the Office of the
Surgeon General of the United States Public Health Service in order to
fulfill the mission of administration and oversight of the Commissioned
Corps of the USPHS,
and be it further
Resolved, that the AGD supports the appointment of the Surgeon General
from the ranks of the Commissioned Corps of the USPHS in keeping with
existing legislation that provides for this result."
Sales tax on professional services - AGD opposition
87:63-H-7
"Resolved, that the AGD recommend that its constituents work with ADA
and Canadian dental societies in opposing sales taxes on professional fees
and services."
State over federal regulation of the dental profession
82:30-H-7
"Resolved, that the AGD supports the principle that in any regulation of the
dental profession the dental health interests of the public are better served
by the state rather than federal regulation."
Student Loan Interest Deduction
87:54-H-7
"Resolved, that the AGD support legislation seeking reinstatement of the
full tax deductibility of interest payments of student loans."
Tax credit in states with reimbursement rates below 75th percentile
2004:15-H-7
"Resolved, that the Academy of General Dentistry seeks a tax credit not to
exceed $5000 for dentists participating in the Medicaid program in states
where reimbursement rates are less than the 75th percentile, and be it
further
Resolved, that the credit be calculated on the difference between the state
Medicaid reimbursement rate and the most recent ADA Annual Fee Survey
75th percentile schedule for the region."
Tobacco Cessation Treatment
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2008:313-H-7
“Resolved, that treatment for tobacco cessation including appropriate
medication is within the scope of dental practice, and be it further
Resolved, that constituents be encouraged to lobby state and provincial
legislatures/dental boards where restrictions exist.”
Tobacco settlement earmarked for health care
2000:29-H-7
“Resolved, that the AGD support having monies from the settlement with
the tobacco industry be earmarked for health care and be it further
Resolved, that this position be communicated to constituent AGD presidents
who should work with state dental associations to see this is implemented in
their respective states.”
Veterans Administration Dental Director
96:57-H-7
RESCINDED HOD 2008
2008:305-H-7
“Resolved, that policy 96:57-H-7 is rescinded.”
Water quality during routine dental treatments should be appropriate
2000:28-H-7
“Resolved, that the AGD supports the use of appropriate water quality
during routine dental treatments.”
Licensing
Limited to dentists and dental hygienists
73:22-H-10
"Resolved, that there be no additional licensing of personnel in the
dental health field other than the dentist and the dental hygienist."
Licensure
By credentials
92:33-H-7
"Resolved, that the Academy of General Dentistry encourage the American
Dental Association and the Canadian Dental Association to advocate a
position that will encourage the various states or provinces to allow
graduates of dental schools accredited by the Joint Commission on
Accreditation of Dental Schools to be licensed by credentials in other states
or provinces by meeting these criteria as a minimum:
1.
Having successfully passed the National Boards and
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94:19-H-7
2.
Having passed a State or Provincial Board of Dental Examiners
exam and/or a regional licensure exam
3.
Having satisfactorily completed a jurisprudence and/or law exam if
required by that state or province and
4.
Having satisfactorily complied with the state or provincial law and
Principles of Ethics of the state or province in which the individual is
currently practicing."
"Resolved that the Academy of General Dentistry actively support licensure
by credentials by providing assistance to any region or constituent
requesting support in promoting the issue at the state level."
Limitation of Practice
*72:10-H-10
RESCINDED HOD 7/2004
Malpractice Insurance and Litigation
Defending their capabilities to render dental procedures
81:12-H-7
"Resolved, that members faced with problems of defending their
capabilities to render certain dental procedures be advised to seek help from
local general practitioners to serve as expert witnesses on their behalf, and
be it further
Resolved, that the AGD assist individual members in need of credentials by
providing them with letters which may indicate any of the following points:
A.
The fact that the individual has been a member in good standing of
the AGD since a specific date.
B.
The number of hours of continuing education on record in the AGD's
central office for the member.
C.
Verification that the individual has achieved Fellowship or
Mastership status in the AGD.
D.
Any of the individual's activities as a member, including the
committees he has served on and the offices he has held in the
AGD."
Mandated Health Benefits
AGD policy on
87:51-H-7
"Resolved, that the Academy of General Dentistry opposes federal and state
laws mandating health and related benefits because such laws may increase
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health care costs, reduce employers' incentives to hire full-time staff
members, increase a trend toward underemployment of auxiliaries, and
reduce incentives for employers to provide health care benefits since such
laws place solo and small group practitioners at an economic disadvantage,
and be it further
Resolved, that Congress and the states should explore alternatives to
government-mandated benefits, including favorable tax incentives that
encourage employer expansion of health care and related benefits."
National Health Program, Dentistry’s Position on
*77:20-H-6
RESCINDED HOD 7/94
National Practitioner Data Bank
94:17-H-7
"Resolved, that the Academy of General Dentistry recommends limiting
access to the National Practitioner Data Bank to those persons and entities
originally authorized to report to and query the data bank by the Health
Care Quality Improvement Act of 1986."
OSHA
AGD efforts to control regulations relating to infectious waste control
89:57-H-7
"Resolved, that the AGD work with the ADA in negotiating with OSHA
and other governmental agencies to make regulations involving infection
control, hazard communication and infectious waste less onerous and more
economical for the general public and the dental profession."
AGD influence in adopting guidelines
89:52-H-7
"Resolved, that the Academy of General Dentistry work to influence the
formation of OSHA guidelines that would protect the privacy and quality of
patient care during the time of office inspection, and be it further
Resolved, that the Academy of General Dentistry request the ADA to
include the following points in its negotiations with OSHA:
1.
Inspectors should allow normal office operation to continue during
inspection.
2.
Inspectors should not interfere with patient care.
3.
Inspectors should not attempt to speak with a dentist who is engaged
in direct patient care or consultation with a patient.
4.
Inspectors should not invade or in any way compromise a patient's
privacy or confidentiality.
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5.
Inspectors should not make comments to a dentist, staff or other
inspectors within patients' hearing."
AGD supports the ADA’s position on OSHA’s anticipated rule on Workplace Safety & Health
Programs
97:28-H-8
“Resolved, that the AGD support the ADA’s position on OSHA’s
anticipated proposed rule on Workplace Safety & Health Programs as
outlined in the letter written by Dr. William S. TenPas and attached to this
report as Addendum A.
The AGD specifically supports an exemption in any final OSHA regulation
on Workplace Safety & Health Programs for both small employers and low
risk employers.”
Worker safety regulation, opposition
93:30-H-7
"Resolved, that the Academy of General Dentistry work in conjunction with
the American Dental Association to oppose any OSHA worker safety
regulations that are not substantiated by scientific documentation."
Patient Records
Confidentiality of
78:22-H-6
"Resolved, that the Academy of General Dentistry support the principle of
maintaining the confidentiality of patients' dental records, and be it further
Resolved, that the Academy of General Dentistry considers the compulsory
in-office audit of dental offices to be an invasion into the confidentiality of
patients' dental records."
Pediatric Dentistry
Defined
95:7-H-7
"Resolved, that the Academy of General Dentistry supports the adoption of
the following revised definition of the specialty of pediatric dentistry:
'Pediatric dentistry is an age-defined specialty that provides primary,
comprehensive, preventive and therapeutic oral health care for infants and
children through adolescence, and may also include the treatment of those
with special health care needs.'"
Peer Review Committees
For general dentists
77:11-H-6
"Resolved, that the peer review mechanisms of organized dentistry be the
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sole factor in determining whether a dentist is qualified to perform a
particular dental service, and be it further
Resolved, that the AGD vigorously oppose the formation of lists of dental
services which might indicate that a general dentist is not qualified to
perform certain procedures."
PSROs (Professional Standards Review Organizations)
*73:19-H-10
RESCINDED HOD 7/99
Quality control review by
76:30-H-11
"Resolved, that the AGD endorses quality control review in the United
States only by peer review committees established by ADA constituents
and rejects the concept that quality review is the prerogative of prepayment
programs."
Seek general practitioner representation on
*75:25-H-10
RESCINDED HOD 7/99
Post Graduate Training
Availability for all recent graduates
92:36-H-7
"Resolved that the Academy of General Dentistry support, with the
American Dental Education Association, the development of one-year
postgraduate training programs accessible to all dental school graduates,
and be it further
Resolved, that the program(s) incorporate the following concepts:
a)
that the program should be in the category of post-graduate
education with an appropriate stipend, and should not be a fifth year
of dental school with potential for increased student indebtedness.
b)
that the program should prepare a dentist for private practice,
incorporating both clinical skill enhancement and practice
management training.
c)
that the Commission on Dental Accreditation should develop and
implement appropriate standards and criteria for such one-year
postgraduate training program, including the definition of credentials
required of program directors.
d)
that program(s) be developed with sufficient flexibility for operation
in the offices of selected practitioners, indigent care centers or public
health sites.
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e)
that participants in post graduate training at public health sites be
eligible for debt repayment programs, and be it further
Resolved that the AGD's position be communicated in writing to both the
ADA's Commission on Dental Accreditation and to the American Dental
Education Association."
Public Information
Monitoring dental health messages to the public
98:20-H-7
“Resolved, that AGD monitor dental health messages communicated to the
public in an effort to see that the interest of the general dentist is properly
reflected.”
Radiographs
Dental assistants must be properly trained to use
80:23-H-7
"Resolved, that AGD recognizes that dental assistants should be properly
trained to safely utilize radiological equipment, and be it further
Resolved, that AGD recognizes the need to have dental radiological
equipment appropriately monitored in order to ensure the safety of the
public, and be it further
Resolved, that AGD encourages the ADA to establish a comprehensive
radiological safety program."
Submission to insurance carriers
*75:26-H-10
RESCINDED
76:56-H-11
RESCINDED HOD 7/2006
2006:22R-H-7
“The AGD endorses the most current radiographic recommendations
developed by the Food and Drug Administration once reviewed by the
appropriate AGD agency which will serve as a guide to the general dentist’s
professional judgment of how to best use diagnostic imaging tools for each
patient, and be it further
Resolved, that policy (76:56-H-11) At all times, decisions relating to the
radiographic exposure of patients shall remain with the dental profession
and shall be accomplished only when there is a benefit to the dental health
of the patient be rescinded.”
Salaried Dentists
90:58-H-7
"Resolved, that the AGD strongly support governmental dentists being
remunerated at a level competitive with dental incomes in the civilian
sector, and be it further
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Resolved, that the AGD support legislative proposals that promote an
increase in remuneration for dentists serving in the government to a level
that is competitive with dentists in the civilian sector."
Sedation
Adequate facilities for teaching
87:57-H-7
"Resolved, that the Academy of General Dentistry use the following
definition to define adequate facilities for the teaching of conscious
sedation at the undergraduate and continuing dental education levels:
'An area equipped with suction, monitoring equipment, emergency drugs,
and equipment to deliver oxygen under positive pressure in relatively quiet
and private surroundings.'"
Teaching of, at the undergraduate and CE levels
86:36-H-7
2008:204-H-7
AMENDED HOD 2008
“Resolved, that the following resolution be amended to read:
“Resolved that policy 86:36-H-7 be amended so that it reads:
"Resolved, that the Academy of General Dentistry supports the teaching of
conscious sedation at the undergraduate and continuing education levels in
dental schools and other adequate teaching facilities as defined by the
AGD's Education Council.”
Smoking
AGD position on use of Tobacco
90:41-H-7
"Resolved, that the Academy of General Dentistry believes that the use of
tobacco has a significantly adverse impact on the public's oral and general
health and encourages its members and all general practice dentists and
members of the dental health team to promote tobacco abstinence through
patient education; and be it further
Resolved, that the AGD encourages all dental offices to serve as model
tobacco-free environments and to work actively within the community to
promote tobacco abstinence and to educate school-age children on the
hazards of tobacco use."
Specialty License Laws
73:20-H-10
"Resolved, that the Academy of General Dentistry continue to oppose the
creation of specialty licensure laws within various states and that state
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Academies should remain vigilant against further expansion of these
programs."
74:11-H-11
"Resolved, that the Academy of General Dentistry express its strong
opposition to development of specialty license laws as part of state dental
practice acts and that the AGD continue to support the position of the
American Dental Association."
Specialty Listings
74:5-H-11
"Resolved, that the Academy of General Dentistry urge its members to
oppose specialty listings whenever proposed because of the adverse effect
such a policy has on selection by the public of a general dentist as the
primary vehicle of entry into the dental care delivery system."
State Board of Dentistry
*85:26-H-7
RESCINDED
94:16-H-7
"Resolved, that in the interest of the dental health of the public, the
Academy of General Dentistry support maintaining the dental licensing
authority at the State Board level, and be it further
Resolved, that the Academy of General Dentistry support a single State
Board(s) of Dentistry in each state, as the sole regulating authority(ies) for
entry level licensure of dentists and hygienists, and be it further
Resolved, that the AGD support state board examinations for entry level
licensure, and be it further
Resolved, that the following policy adopted by the AGD's 1985 House of
Delegates be rescinded:
Resolved, that in the interest of the dental health of the public, the Academy
of General Dentistry supports a single State Board of Dentistry in each state,
as the sole regulating authority for the delivery of dental care, and be it
further
Resolved that the following resolution be sent to the ADA's 1985 House of
Delegates:
'Resolved, that the American Dental Association, in the interest of
the dental health of the public, supports a single State Board of
Dentistry in each state, as the sole regulating authority for the
delivery of dental care'
and be it further
Resolved, that the following resolution be sent to the ADA's 1994 House of
Delegates:
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'Resolved that the American Dental Association, in the interest of the
dental health of the public, support maintaining the dental licensing
authority at the State level and be it further
Resolved, that the American Dental Association support a single State
Board of Dentistry in each state, as the sole regulating authority for entry
level licensure of dentists and hygienists', and be it further
Resolved that the ADA support state board examination for entry level
licensure."
Sterilization
Procedures
92:25-H-7
"Resolved, that the Academy of General Dentistry believes the public good
is best served by sterilization procedures for the dental office that provide
patients with maximum protection against any possibility of cross
contamination and that demonstrate the dentist's commitment to patient
health and safety, and be it further
Resolved, that the AGD reaffirms its policy of sterilization by currently
accepted methods, including heat sterilization of dental instruments between
every patient, and be it further
Resolved, that the Academy of General Dentistry work with the American
Dental Association, the Canadian Dental Association, the National Dental
Association, and the Centers for Disease Control to encourage all dentists to
follow this policy and to raise public awareness of the safety of the dental
office and the measures that ensure health and safety of the public and of all
involved in dental care delivery."
Surveys
Of dental schools, annually
94:23-H-7
"Resolved, that the annual survey of dental schools to investigate the
progress toward an academic postgraduate degree or other recognition for
the general practitioner be discontinued as it is no longer effective in
evaluating the activities of dental schools with regard to the training of
general dentists."
Table of Allowances
Acceptable reimbursement mechanism
76:52-H-11
"Resolved, that the Academy of General Dentistry go on record as
endorsing the table of allowances as an acceptable reimbursement
mechanism."
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VI. Access and Prevention
General
Since the release of the Surgeon General’s Report on Oral Health, many organizations have
begun to focus on access to oral health care issues. As constituent chairperson of dental
care/practice, you must be aware of means by which your constituent can become involved in
ways to increase access to oral health care for the populations that you serve.
There are many examples of programs at state and organizational levels that can be found by
using your Internet web-browser. Go to a browser (e.g., type in the URL, www.google.com, or
www.excite.com) then, in the search field type, “dental care, access.” Your search will return a
plethora of reports on state programs, examples of groups banding together to provide care,
legislative agendas, local clinics, and many areas where your constituent can research or become
involved in access to care issues. Involvement can be at any level including support for
legislative action, provision of care, aid in administration of clinics, or sitting on the boards of
non-profit entities. Your efforts in the support of access to care are limited only by your
collective imaginations. As leaders in our communities in the field of oral health, we must take
the initiative to become problem solvers in this major health concern.
William Maas, DDS, MPH, former Chief Dental Officer of the U.S. Public Health Service,
believes that while community efforts by individual doctors to provide clinical care are
important, it is the efforts of organizations such as the AGD and the members of its constituents
that make the biggest difference. When members help in the organization and administration of
urban or rural community oral health efforts, especially in the dissemination of our knowledge
and organizational skills, we can multiply those talents many-fold over the impact of any of us
individually.
Medicaid administration, reimbursement, and utilization all need to be improved. In order to
increase access to care for disadvantaged populations, active involvement at the constituent level
in the area of lobbying for improvement of legislation for Medicaid programs must continue.
Cumbersome regulations and paperwork, poor reimbursement rates, and poor prioritization of
treatment utilization contribute to the dearth of practitioners willing to become or to continue as
Medicaid providers. Making the provision of Medicaid care a more effective and rewarding
experience for dentists will go a long way toward improving access to care for populations.
Constituent leaders should become students of modalities that provide cost-effective and
necessary preventive and restorative care for disadvantaged populations. Constituent bodies can
then leverage their expertise when lobbying with local and state legislators to improve the
Medicaid system.
AGD Access to Care White Paper
In 2008, the AGD HOD passed the White Paper on Increasing Access to and Utilization of Oral
Health Care Services (White Paper). Please visit the AGD site and read/familiarize yourself with
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the White Paper as it argues succinctly against the establishment of non-dentists (independent
midlevel providers) to provide dentistry and for approximately 30 solutions to access to care that
are tried and true, and must be funded in order to improve care in the United States. You will be
asked to use this policy to take further action with state boards, legislators, dental organizations,
the public, and other communities of interest within your constituent!
Prevention
The use of fluoride in the prevention of dental caries has been supported by the dental profession
for years. In a study backed by the Centers for Disease Control and Prevention, dated August 17,
2001, and titled Recommendations for Using Fluoride to Prevent and Control Dental Caries in
the United States, in-depth recommendations for fluoride indications and use are discussed.
The report includes sections on: 1) How Fluoride Prevents and Controls Dental Cares; 2) Risk
for Dental Caries; 3) Risk for Enamel Fluorosis; 4) National Guidelines for Fluoride Use; 5)
Fluoride Sources and Their Effects—subsections include a) Drinking Water, b) Bottled Water, c)
Fluoride Toothpaste, d) Professionally Applied Fluoride Compounds, and more; 6) Quality of
Evidence for Dental Caries Prevention and Control; 7) Cost-Effectiveness of Fluoride
Modalities; 8) Recommendations; and 9) Conclusion. Also included are charts showing the
method of action of fluoride in remineralization of enamel and a map of state populations by
percentage with access to fluoridated water supplies.
Additionally, in the prevention and control of dental caries, community water fluoridation is
strongly recommended. It was found that in municipal water supplies starting or continuing
community water fluoridation (CWF) effectively prevents dental caries at varying levels, and
conversely stopping CWF resulted in increased rates of caries in communities where that
occurred.
The ADA Web site also has a wealth of information. There are statements from the ADA
addressing fluoride use, facts about fluoride safety, and a list of non-ADA Internet sites that
provide information on fluorides and fluoridation issues.
Again, as the oral health professionals in our communities, it is incumbent upon all of us to stay
informed in caries and periodontal disease prevention modalities, as well as other oral health
components and linkages to overall health.
Our offices can be centers for the dissemination of learning materials for our patients that are
geared toward their levels of understanding. The Dental Practice Council is actively involved in
improving health literacy for various populations. Further developments are forthcoming.
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VII. Workforce / Independent Midlevel Providers
As a constituent leader, you will undoubtedly be faced with proposals or discussions in your state
regarding whether to implement non-dentists working without the direct supervision of a dentist
to provide care to patients. However, certain care falls within the scope of dentistry and should
require the minimal education of a dentist to engage in.
You will be asked to stand up and be the voice of your constituent for the profession of dentistry
and the well-being of patients in your state.
AGD HOD policy recognizes the dentist as the captain of the dental team, the person to ensure
the optimal oral health of the public he or she serves, and the only dental team member with the
complete education and training to form a diagnosis, create a comprehensive treatment plan, and
perform irreversible procedures, surgeries, and other treatments that will physically alter the
patient. Direct supervision of the dental team by the dentist is critical to ensuring the safety and
well-being of the patient.
The AGD believes its core principles and values are in the best interest of its patients and the
profession, and it is for this reason that these principles and values will not be subject to
alteration in response to outside influences and/or agendas.
AGD’s individual policies on workforce are encapsulated in Section V above. However, for your
convenience, please read the online summary of AGD’s policies here.
VIII. Available Resources
General
The following pages contain information that is available to you. You may also want to use this
section to store additional mailings you receive from AGD Headquarters.
Resource Staff
The following individual is available to you throughout your tenure as your Constituent’s Dental
Care/Practice Chair.
Srinivasan (Srini) Varadarajan, JD
Director, Dental Practice Advocacy
Academy of General Dentistry
211 East Chicago Avenue, Suite 900
Chicago, IL 60611-1999
888.243.3368, ext. 4973
312.440.4973 Direct Line
312.335.3454 Fax
srini.varadarajan@agd.org
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2010-2011 AGD Dental Practice Council
The following Council members can offer assistance and guidance with constituent dental care activities.
Joseph Battaglia, DMD, FAGD
Chair
516 Hamburg Tpke Ste 9
Wayne, NJ 07470-2063
Office: 973.595.1888
Fax: 973.595.1353
E-mail: battagja@prodigy.net
Willis Hardesty, Jr., DDS, FAGD
2321 Blue Ridge Rd. Ste 103
Raleigh, NC 27607-6453
Office: 919.781.0018
Fax: 919.571.9114
E-mail: doctorstan@nc.rr.com
Richard Kanter, DMD, FAGD
Board Liaison
801 W. Fletcher Ave.
Tampa, FL 33612-3424
Office: 813.961.1727
Fax: 813.968.7220
E-mail: rkanter48@aol.com
Susan Bishop, DMD, MAGD
Division Coordinator
7314 N. Edgewild Dr.
Peoria, IL 61614-2114
Office: 309.679.6141
Fax: 309.692.1796
E-mail: sbishop@peoriacounty.org
Robert Margolin, DDS, FAGD
1 Fountain Ln Apt. 3L
Scarsdale, NY 10583-4656
Office: 718.220.2020 ext. 8967
Fax: 718.960.9350
E-mail: robm@prodigy.net
Myron J. Bromberg, DDS
Consultant
7012 Reseda Boulevard, Suite G
Reseda, CA 91335
Office: 818.345.3366
Fax: 818.345.4958
E-mail: drmikebromberg@earthlink.net
Dan McCauley, DDS, FAGD
1603 N. Jefferson Ave.
Mount Pleasant, TX 75455-2329
Office: 903.572.3981
Fax: 903.577.0643
E-mail: drdansmu@hotmail.com
Richard Crowder, DDS
14922 W 87th Street Pkwy
Lenexa, KS 66215-4159
Office: 913.322.2222
Fax: 913.825.9177
E-mail: drc@crowderfamilydentistry.com
Anita Rathee, DDS
23101 Sherman Pl Ste 415
West Hills, CA 91307-2037
Office: 818.348.8898
Fax: 818.348.1841
E-mail: ratheedds@gmail.com
John W. Drumm, DMD
3301 New Mexico Avenue NW, #230
Washington, DC 20016
Office: 202.244.1601
Fax: 202.244.1604
E-mail: drjohndrumm@aol.com
M. Samantha Shaver, DMD, FAGD
7926 Preston Hwy
Preston Medical Ctr Ste 201
Louisville, KY 40219-3848
Office: 502.968.1412
Fax: 502.968.8797
E-mail: samsworld@aol.com
Richard Dycus, DDS, MAGD
1005 E 6th St
Cookeville, TN 38501-2830
Office: 931.528.7977
Fax: 931.528.7987
E-mail: rdycus@frontiernet.net
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Resource Materials
The following resources will be available to you throughout your tenure as your Constituent’s
Dental Care Chair.
1.
Twice each year, a summary report noting the activities and issues of the most
recent meeting of the AGD’s Dental Practice Council, will be provided to you
along with pertinent information on dental care issues and the most current
regional listing of constituent chairpersons available.
2.
You will receive a short annual Constituent Dental Care Questionnaire or other
communication from the members of the Dental Practice Council that you will
be asked to respond to. You may be asked to identify and to discuss key dental
care issues taking place within your state as well as the type of relationship you
have with your state dental association. Your input will greatly aid the Dental
Practice Council in advocating for the general dentist.
4.
You will also receive updates to the Constituent Dental Care Resource Manual
and other materials as warranted.
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State Dental Association Contacts, Telephone Numbers, and Addresses
Listed below are the contact names, telephone numbers, and addresses for each state dental
association.
Alabama Dental Association
Dr. Zack Studstill
Interim Executive Director
836 Washington Avenue
Montgomery, AL 36104-3839
334.265.1684 (Office)
334.262.6218 (Fax)
www.aldaonline.org
California Dental Association
Mr. Peter DuBois
Executive Director
1201 K Street
Sacramento, CA 95814
916.443.0505 (Office)
916.443.2943 (Fax)
peter.dubois@cda.org
www.cda.org
Alaska Dental Society
Mr. Jim Towle
Executive Director
9170 Jewel Lake Road, Suite 203
Anchorage, AK 99502-5381
907.563.3003 (Office)
907.563.3009 (Fax)
JTowle@akdental.org
www.akdental.org
Colorado Dental Association
Mr. Jim Young
Executive Director
3690 S. Yosemite, Suite 100
Denver, CO 80237-1808
303.740.6900 (Office)
303.740.7989 (Fax)
info@cdaonline.org
www.cdaonline.org
Arizona State Dental Association
Mr. Kevin B. Earle
Executive Director
3193 Drinkwater Boulevard
Scottsdale, AZ 85251-6491
480.344.5777 (Office)
480.344.1442 (Fax)
azda@azda.org
www.azda.org
Connecticut State Dental Association
Ms. Carol Dingeldey
Executive Director
835 West Queen St.
Southington, CT 06489
860.378.1800 (Office)
860.378.1807 (Fax)
cdingeldey@csda.org
www.csda.com
Arkansas State Dental Association
Mr. Billy Tarpley
Executive Director
7480 Hwy 107
Sherwood, AR 72120
501.834.7650 (Office)
501.834.7657 (Fax)
billy-asda@comcast.net
www.dental-asda.org
Delaware State Dental Society
Ms. Betty J. Dencler
Executive Director
The Christiana Executive Campus
200 Continental Drive, Suite 111
Newark, DE 19713
302.368.7634 (Office)
302.368.7669 (Fax)
dsds@dol.net
www.delawarestatedentalsociety.org
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208.343.7543 (Office)
208.343.0775 (Fax)
quinn@isdowela.com
www.isdaweb.com
District of Columbia Dental Society
Mr. C. Jay Brown, CAE
Executive Director
502 C Street, NE
Washington, D.C. 20002-5810
202.547.7613 (Office)
202.546.1482 (Fax)
info@dcdental.org
www.dcdental.org
Illinois State Dental Society
Mr. Greg Johnson
Executive Director
1010 S. Second Street
P.O. Box 376
Springfield, IL 62705
217.525.1406 (Office)
217.525.8872 (Fax)
gjohnson@isds.org
www.isds.org
Florida Dental Association
Mr. Daniel J. Buker, Jd, MS
Executive Director
1111 E. Tennessee Street, Suite 102
Tallahassee, FL 32308-6913
850.681.3629 (Office)
850.561.0504 (Fax)
fda@floridadental.org
www.floridadental.org
Indiana Dental Association
Mr. Douglas M. Bush
Executive Director
P.O. Box 2467
Indianapolis, IN 46206-2467
317.634.2610 (Office)
317.634.2612 (Fax)
doug@indental.org
www.indental.org
Georgia Dental Association
Ms. Martha S. Phillips
Executive Director
7000 Peachtree Dunwoody Road, NE
Suite 200, Building 17
Atlanta, GA 30328-1655
404.636.7553 (Office)
404.633.3943 (Fax)
phillips@gadental.org
www.gadental.org
Iowa Dental Association
Mr. Lawrence F. Carl, CAE
Executive Director
5530 West Parkway, Suite 100
Johnston, IA 50131
515.986.5605 (Office)
515.986.5626 (Fax)
info@iowadental.org
www.iowadental.org
Hawaii Dental Association
Mr. Loren Liebling
Executive Director
1345 S. Beretania Street, Suite 301
Honolulu, HI 96814-1821
808.593.7956 (Office)
808.593.7636 (Fax)
hda@hawaiidentalassociation.net
www.hawaiidentalassociation.net
Kansas Dental Association
Mr. Kevin J. Robertson, CAE
Executive Director
5200 SW Huntoon Street
Topeka, KS 66604-2398
785.272.7360 (Office)
785.272.2301 (Fax)
kevin@ksdental.org
www.ksdental.org
Idaho State Dental Association
R. Quinn Dufurrena, DDS, JD
Executive Director
1220 W. Hays Street
Boise, ID 83702-5315
123
For AGD Constituent Use Only
612.767.8500 (Fax)
info@mndental.org
www.mndental.org
Kentucky Dental Association
Mr. Michael R. Porter
Executive Director
1920 Nelson Miller Parkway
Louisville, KY 40223-2164
502.489.9121 (Office)
502.489.9124 (Fax)
mike@kyda.org
www.kyda.org
Mississippi Dental Association
Ms. Connie F. Lane
Executive Director
2630 Ridgewood Road, Suite C
Jackson, MS 39216-4903
601.982.0442 (Office)
601.366.3050 (Fax)
connie@msdental.org
www.msdental.org
Louisiana Dental Association
Mr. Ward Blackwell
Executive Director
7833 Office Park Boulevard
Baton Rouge, LA 70809-7604
225.926.1986 (Office)
225.926.1886 (Fax)
info@ladental.org
www.ladental.org
Missouri Dental Association
Ms. Vicki Wilbers
Executive Director
3340 American Avenue
Jefferson City, MO 65109
573.634.3436 (Office)
573.635.0764 (Fax)
vicki@modental.org
www.modental.org
Maine Dental Association
Ms. Frances C. Miliano
Executive Director
P.O. Box 215
Manchester, ME 04351-0215
207.622.7900 (Office)
207.622.6210 (Fax)
info@medental.org
www.medental.org
Montana Dental Association
Ms. Mary McCue, Esq.
Executive Director
171/2 Last Chance Gulch
P.O. Box 1154
Helena, MT59624
406.443.2061 (Office)
406.443.1546 (Fax)
mda@mt.net
www.mtdental.com
Michigan Dental Association
Mr. Drew Eason, CAE
Executive Director
3657 Okemos Road, Suite 200
Okemos, MI 48864-3927
517.372.9070 (Office)
517.372.0008 (Fax)
mda@michigandental.org
www.smilemichigan.com
Nebraska Dental Association
Mr. David J. O’Doherty
Executive Director
7160 South 29th Street, Suite 1
Lincoln, NE 68516
402.476.1704 (Office)
402.476.2641 (Fax)
info@nedental.org
www.nedental.org
Minnesota Dental Association
Mr. Richard Diercks
Executive Director
1335 Industrial Blvd.
Minneapolis, MN 55413
612.767.8400 ext. 100 (Office)
124
For AGD Constituent Use Only
518.465.0044 (Office)
518.465.3219 (Fax)
info@nysdental.org
www.nysdental.org
Nevada Dental Association
Dr. Robert Talley
Executive Director
8863 W. Flamingo Road, Suite 102
Las Vegas, NV 89147702.255.4211 (Office)
702.255.3302 (Fax)
robert.talleydds@nvda.org
www.nvda.org
North Carolina Dental Society
Dr. M. Alec Parker
Executive Director
1600 Evans Road
Cary, NC 27513
919.677.1396 (Office)
919.677.1397 (Fax)
aparker@ncdental.org
www.ncdental.org
New Hampshire Dental Society
Mr. James J. Williamson
Executive Director
23 S. State Street
Concord, NH 03301
603.225.5961 (Office)
603.226.4880 (Fax)
nhds@nhds.org
www.nhds.org
North Dakota Dental Association
Mr. Joseph J. Cichy
Executive Director
P.O. Box 1332
Bismarck,ND 58502-1332
701.223.8870 (Office)
701.223.0855 (Fax)
ndda@midconetwork.com
www.nddental.com
New Jersey Dental Association
Mr. Arthur Meisel, Esq.
Executive Director
One Dental Plaza
P.O. Box 6020
North Brunswick, NJ 08902-6020
732.821.9400 (Office)
732.821.1082 (Fax)
ameisel@njda.org
www.njda.org
Ohio Dental Association
Mr. David J. Owsiany, JD
Executive Director
1370 Dublin Road
Columbus, OH 43215-1098
614.486.2700 (Office)
614.486.0381 (Fax)
dentist@oda.org
www.oda.org
New Mexico Dental Association
Mr. Mark D. Moores
Executive Director
9201 Montgomery Boulevard NE,
Suite 601
Albuquerque, NM 87111
505.294.1368 (Office)
505.294.9958 (Fax)
mmoores@nmdental.org
www.nmdental.org
Oklahoma Dental Association
Ms. Lynn Means
Executive Director
317 NE 13th Street
Oklahoma City, OK 73104
405.848.8873 (Office)
405.848.8875 (Fax)
information@okda.org
www.okda.org
New York State Dental Association
Dr. Mark J. Feldman
Acting Executive Director
20 Corporate Wood Blvd., #602
Albany, NY 12211
125
For AGD Constituent Use Only
Columbia, SC 29210
803.750.2277 (Office)
803.750.1644 (Fax)
latham@scda.org
www.scda.org
Oregon Dental Association
Mr. William E. Zepp, CAE
Executive Director
P.O. Box 3710
Wilsonville, OR97070-3710
503.218.2010 (Office)
503.218.2009 (Fax)
bzepp@oregondental.org
www.oregondental.org
South Dakota Dental Association
Mr. Paul Knecht
Executive Director
804 N. Euclid, Suite 103
P.O. Box 1194
Pierre, SD 57501
605.224.9133 (Office)
605.224.9168 (Fax)
paul@sddental.org
www.sddental.org
Pennsylvania Dental Association
Ms. Camille Kostelac-Cherry, Esq.
CEO
3501 North Front St.
P.O. Box 3341
Harrisburg, PA 17105-3341
717.234.5941 (Office)
717.234.2186 (Fax)
ckc@padental.org
www.padental.org
Tennessee Dental Association
Mr. David S. Horvat
Executive Director
660 Bakers Bridge Avenue, Suite 300
Franklin, TN 37067
615.628.0208 (Office)
tda@tenndental.org
www.tenndental.org
Colegio De Cirujanos Dentistas De Puerto
Rico
Dra. Dalia E. Verge Quiles
Executive Director
200 Calle Manuel V. Domenech Hato Rey,
PR 00918
787.764.1969 (Office)
787.763.6335 (Fax)
dentista@ccdpr.org
www.ccdpr.org
Texas Dental Association
Ms. Mary Kay Linn
Executive Director
1946 South IH-35, Suite 400
Austin, TX 78704
512.443.3675 (Office)
512.443.3031 (Fax)
marykay@tda.org
www.tda.org
Rhode Island Dental Association
Ms. Valerie G. Celentano
Executive Director
875 Centerville Commons, Bldg. 4, Suite 12
Warwick, RI 02886
401.825.7700 (Office)
401.825.7722 (Fax)
ridental@ridental.com
www.ridental.com
Utah Dental Association
Mr. Monte Thompson
Executive Director
1151 East 3900 South, Suite 160
Salt Lake City, UT 84124-1255
801.261.5315 (Office)
801.261.1235 (Fax)
uda@uda.org
www.uda.org
South Carolina Dental Association
Mr. Phil Latham
Executive Director
120 Stonemark Lane
126
For AGD Constituent Use Only
Vermont State Dental Society
Mr. Peter Taylor
Executive Director
100 Dorset Street, Suite 18
South Burlington, VT 05403-6241
802.864.0115 (Office)
802.864.0116 (Fax)
ptaylorvt@aol.com
www.vsds.org
Wisconsin Dental Association
Mr. Mark Paget
Executive Director
6737 W. Washington St., Suite 2360
West Allis, WI 53214
414.276.4520 (Office)
414.276.8431 (Fax)
mpaget@wda.org
www.wda.org
Virginia Dental Association
Dr. Terry D. Dickinson
Executive Director
7525 Staples Mill Road
Richmond, VA 23228
804.261.1610 (Office)
804.261.1660 (Fax)
dickinson@vadental.org
www.vadental.org
Wyoming Dental Association
Ms. Diane Bouzis
259 South Center Suite 201
Casper, WY 82601
307.237.1186 (Office)
307.237.1186 (Fax)
wyodental@gmail.com
www.wyda.org
Air Force Dental Corps
Maj Katherine Morganti
Bolling Air Force Base
110 Luke Avenue SW, Room 300
Washington, D.C. 20032
202.404.4119 (Office)
Katherine.morganti@pentagon.af.mil
www.airforce.com
Washington State Dental Association
Mr. Stephen A. Hardymon
Executive Director
126 NW Canal St.
Seattle, WA 98107
206.448.1914 (Office)
206.443.9266 (Fax)
steve@wsda.org
www.wsda.org
Army Dental Corps
Col Kay Malone
Bldg 4011, MCCS-HE
1750 Greeley Road
Fort Sam Houston, TX 78234-5075
210.295.9604 (Office)
Kay.malone@amedd.army.mil
www.goarmy.com/amedd/dental/index.jsp
West Virginia Dental Association
Mr. Richard D. Stevens
Executive Director
2016 1/2 Kanawha Boulevard East
Charleston, WV 25311
304.344.5246 (Office)
304.344.5316 (Fax)
wvrds@aol.com
www.wvdental.org
Navy Dental Corps
LCDR Wade Wallace
2300 E Street NW
Washington, D.C. 20372-5300
901.874.9381 (Office)
Wade.wallace@navy.mil
www.navy.com/careers/officer/healthcare/de
ntistry
127
For AGD Constituent Use Only
Veterans Affairs
Dr. Robert Frame
Asst. Undersecretary for Health for Dentistry
810 Vermont Avenue, NW
Washington, D.C. 20420-0001
202.273.8503 (Office)
202.273.9105 (Fax)
www.vacareers.va.gov
Department Of Defense
Dr. Lawrence D. McKinley
Tricare Management Activity
Skyline 5, Suite 810
5111 Leesburg Pike
Washington, D.C. 22041-3206
703.681.0064 (Office)
703.681.3681 (Fax)
U.S. Public Health Service
Dr. Chris Halliday
Indian Health Service
Division of Oral Health
801 Thompson Avenue, Ste. 300
Rockville, MD 20832
301.443.4320 (Office)
301.594.6610 (Fax)
christopher.halliday@mail.ihs.gov
www.dentist.ihs.gov
www.defenselink.mil
128
For AGD Constituent Use Only
State Departments of Insurance
Listed below are the contact names, telephone numbers, and addresses for each State Department
of Insurance:
National Association of Insurance Commissioners (NAIC)
Headquarters:
2301 McGee Street, Suite 800
Kansas City, MO 64108-2662
Office: 816.842.3600
Fax: 816.783.8175
Alabama
Jim L. Ridling, Commissioner
Alabama Department of Insurance
201 Monroe Street, Suite 502
Montgomery, AL 36104
Office: 334.269.3550
Fax: 334.241.4192
800.433.3966 (State Only)
Alaska
Linda Hall, Director
Robert B. Atwood Building
550 West 7th Avenue, Suite 1560
Anchorage, AK 99501-3567
Office: 907.269.7900
Fax: 907.269.7910
800.467.8725 (State Only)
Arizona
Christina Urias, Director
Arizona Department of Insurance
2910 North 44th Street, Suite 210
Phoenix, AZ 85018-7256
Office: 602.364.2499
Fax: 602.364.2505
Arkansas
Jay Bradford, Commissioner
Arkansas Department of Insurance
1200 West 3rd Street
Little Rock, AR 72201-1904
Office: 501.371.2600
Fax: 501.371.2618
800.852.5494 (Consumers)
800.282.9134 (Toll-Free)
800.224.6330 (Seniors Only)
California
Steve Poizner, Commissioner
California Department of Insurance
300 Capitol Mall, Suite 1700
Sacramento, CA 95814
Office: 916.492.3500
Fax: 916.445.6552
800.927.4357 (State Only)
State of California
Legal Division
45 Fremont Street, 23rd Floor
San Francisco, CA 94105
Office: 415.538.4010
Fax: 415.904.5889
Consumer Services Division
300 South Spring Street, South Tower
Los Angeles, CA 90013
Office: 213.897.8921
800.927.4357 (State Only)
129
For AGD Constituent Use Only
Colorado
Mary Morrison, Commissioner
Colorado Division of Insurance
1560 Broadway, Suite 850
Denver, CO 80202
Office: 303.894.7499
Fax: 303.894.7455
800.930.3745 (State Only)
Connecticut
Thomas R. Sullivan, Commissioner
Connecticut Department of Insurance
P.O. Box 816
Hartford, CT 06142-0816
Office: 860.297.3800
Fax: 860.566.7410
800.203.3447 (State Only)
153 Market Street, 7th Floor
Hartford, CT 06103
Delaware
Karen Weldin Stewart, Commissioner
Delaware Department of Insurance
Rodney Building
841 Silver Lake Boulevard
Dover, DE 19904
Office: 302.674.7310
Fax: 302.739.5280
800.282.8611 (State Only)
District of Columbia
Gennet Purcell, Esq., Acting Commissioner
Department of Insurance, Securities & Banking
Government of the District of Columbia
810 First Street, N.E., Suite 701
Washington, DC 20002
Florida
Kevin McCarty, Commissioner
Office of Insurance Regulation
The Larson Building
200 East Gaines Street, Room 101A
Tallahassee, FL 32399-0301
Office: 202.727.8000
Fax: 202.535.1196
Office: 850.413.5914
Fax: 850.488.3334
800.342.2762 (Helpline)
Georgia
John Oxendine, Commissioner
Georgia Department of Insurance
2 Martin Luther King Jr. Drive
West Tower, 704
Atlanta, GA 30334
Office: 404.656.2070
Fax: 404.657.8542
800.656.2298 (State Only)
130
For AGD Constituent Use Only
Hawaii
Gordon Ito, Commissioner
Hawaii Insurance Division
Department of Commerce & Consumer Affairs
P.O. Box 3614
Honolulu, HI 96811-3614
Office: 808.586.2790
Fax: 808.586.2806
335 Merchant Street, Room 213
Honolulu, HI 96813
Idaho
William Deal, Director
Idaho Department of Insurance
700 West State Street, 3rd Floor
Boise, ID 83720-0043
Office: 208.334.4250
Fax: 208.334.4398
800.721.3272 (State Only)
Illinois
Michael McRaith, Director of Insurance
Illinois Department of Insurance
320 West Washington Street, 4th Floor
Springfield, IL 62767-0001
Office: 217.785.4515
Fax: 217.782.5020
877.527.9431 (Toll-Free)
100 West Randolph Street, Suite 9-301
Chicago, IL 60601-3395
Office: 312.814.2420
Fax: 312.814.5416
Indiana
Carol Cutter, Commissioner
Indiana Department of Insurance
311 West Washington Street, Suite 300
Indianapolis, IN 46204-2787
Office: 317.232.2385
Fax: 317.232.5251
Iowa
Susan Voss, Commissioner
Iowa Insurance Division
330 East Maple Street
Des Moines, IA 50319
Office: 515.281.5705
Fax: 515.281.3059
877.955.1212 (State Only)
Kansas
Sandy Praeger, Commissioner
Kansas Insurance Department
420 S.W. 9th Street
Topeka, KS 66612-1678
Office: 785.296.3071
Fax: 785.296.7805
800.432.2484 (State Only)
131
For AGD Constituent Use Only
Kentucky
Sharon P. Clark, Commissioner
Kentucky Office of Insurance
P.O. Box 517
Frankfort, KY 40602-0517
Office: 502.564.3630
Fax: 502.564.1453
800.595.6053 (State Only)
800.648.6056 (TTY)
215 West Main Street
Frankfort, KY 40601
Louisiana
James J. Donelon, Commissioner
Louisiana Department of Insurance
Attn: Chad Brown
P.O. Box 94214
Baton Rouge, LA 70804-9214
Office: 225.342.5900
Fax: 225.342.8622
800.259.5300 (State Only)
800.259.5301 (State Only)
1702 North 3rd Street
Baton Rouge, LA 70802
Maine
Mila Kofman, Superintendent
Maine Bureau of Insurance
Department of Professional & Financial Regulations
State House Station
Augusta, ME 04333-0034
Office: 207.624.8475
Fax: 207.624.8599
800.300.5000 (State Only)
76 Northern Avenue
Gardiner, ME 04345
Maryland
Elizabeth Sammis, Commissioner
Maryland Insurance Administration
200 St. Paul Place, Suite 2700
Baltimore, MD 21202-2272
Office: 410.468.2090
Fax: 410.468.2020
800.492.6116 (Toll Free)
800.846.4069 (Fraud)
800.735.2258 (TTY)
Massachusetts
Joseph G. Murphy, Commissioner
Massachusetts Office of Consumer Affairs
& Business Regulation Division of Insurance
1000 Washington St., 8th Floor
Boston, MA 02118-2218
Office: 617.521.7794
Fax: 617.753.6830
617.521.7794 (Hotline)
132
For AGD Constituent Use Only
Michigan
Ken Ross, Commissioner
State of Michigan
Office of Financial & Insurance Services
Attn: Office of the Commissioner
P.O. Box 30220
Lansing, MI 48909
Office: 517.373.0220
Fax: 517.335.4978
877.999.6442 (Toll-Free)
Ottawa Building, 4th Floor
611 West Ottawa
Lansing, MI 48913
Minnesota
Glenn Wilson, Commissioner
Minnesota Department of Commerce
85 7th Place East, Suite 500
St. Paul, MN 55101-2198
Office: 651.296.4026
Fax: 651.282.2568
Mississippi
Mike Chaney, Commissioner
Mississippi Insurance Department
P.O. Box 79
Jackson, MS 39205
Office: 601.359.3569
Fax: 601.359.2543
800.562.2957 (State Only)
1001 Woolfolk State Office Building
501 North West Street
Jackson, MS 39201
Missouri
John M. Huff, Director
Missouri Department of Insurance
301 West High Street, Suite 530
Jefferson City, MO 65101
Office: 573.751.4126
Fax: 573.751.1165
800.726.7390 (State Only)
Montana
Monica J. Lindeen, Commissioner
Montana Department of Insurance
840 Helena Avenue
Helena, MT 59601
Office: 406.444.3497
Fax: 406.444.1980
800.332.6148 (State Only)
Nebraska
Ann M. Frohman, Director
Nebraska Department of Insurance
Terminal Building, Suite 400
941 O Street
Lincoln, NE 68508
Office: 402.471.2201
Fax: 402.471.4610
877.564.7323 (State Only)
133
For AGD Constituent Use Only
Nevada
Brett J. Barratt, Commissioner
Nevada Division of Insurance
788 Fairview Drive, Suite 300
Carson City, NV 89701-5753
Office: 775.687.4270
Fax: 775.687.3937
800.992.0900 (State Only)
888.872.3234 (Health
Complaints-State Only)
New Hampshire
Roger A. Sevigny, Commissioner
New Hampshire Insurance Department
21 South Fruit Street, Suite 14
Concord, NH 03301
Office: 603.271.2261
Fax: 603.271.1406
800.852.3416 (Toll-Free)
New Jersey
Thomas B. Considine, Commissioner
New Jersey Department of Insurance
20 West State Street, PO Box 325
Trenton, NJ 08625
Office: 609.292.7272
Fax: 609.777.0508
800.446.7467 (Toll-Free)
New Mexico
John G. Franchine, Superintendent
New Mexico Department of Insurance
P.O. Drawer 1269
Santa Fe, NM 87504-1269
Office: 505.827.4601
Fax: 505.476.0326
800.427.4722 (State Only)
PERA Building
1120 Paseo de Peralta
Santa Fe, NM 87501
New York
James J. Wrynn, Superintendent
New York State Insurance Department
25 Beaver Street
New York, NY 10004-2319
Office: 212.480.6400
Fax: 212.480.2310
800.342.3736 (Toll-Free)
888.372.8369 (Fraud)
New York Department of Insurance
One Commerce Plaza, Suite 1700
Albany, NY 12257
Office: 518.474.6600
Fax: 518.473.4139
North Carolina
Wayne Goodwin, Commissioner
North Carolina Department of Insurance
1201 Mail Service Center
Raleigh, NC 27699-1201
Office: 919.733.3058
Fax; 919.733.6495
800.546.5664 (State Only)
Dobbs Building
430 North Salisbury Street
Raleigh, NC 27603
134
For AGD Constituent Use Only
North Dakota
Adam Hamm, Commissioner
North Dakota Department of Insurance
600 East Boulevard Ave., 5th Floor
Bismarck, ND 58505-0320
Office: 701.328.2440
Fax: 701.328.4880
800.247.0560 (State Only)
Ohio
Mary Jo Hudson, Director
Ohio Department of Insurance
50 West Town Street Third Floor, Suite 300
Columbus, OH 43215-1067
Office: 614.644.2658
Fax: 614.644.3743
800.686.1526 (Toll-Free)
800.686.1527 (Fraud)
800.891.5318 (CE)
800.686.1578 (OHIIP)
Oklahoma
Kim Holland, Commissioner
Oklahoma Department of Insurance
Five Corporate Plaza
3625 NW 56th, Suite 100
Oklahoma City, OK 73107
Office: 405.521.2828
Fax: 405.521.6635
800.522.0071 (State Only)
Oregon
Teresa D. Miller, Insurance Administrator
Oregon Insurance Division
P.O. Box 14480
Salem, OR 97309-0405
Office: 503.947.7980
Fax: 503.378.4351
888.877.4894 (State Only)
350 Winter Street NE
Salem, OR 97301-3883
Pennsylvania
Joel Ario, Commissioner
Pennsylvania Insurance Department
Commonwealth of Pennsylvania
1326 Strawberry Square, 13th Floor
Harrisburg, PA 17120
Office: 717.783.0442
Fax: 717.772.1969
877.881.6388 (Consumer)
Puerto Rico
Ramon Cruz Colon, Commissioner
Office of the Commissioner of Insurance
B5 Calle Tabonuco St.
Suite 216 PMB 356
Guaynabo, PR 00968-3029
Office: 787.722.8686
Fax: 787.273.6082
135
For AGD Constituent Use Only
Rhode Island
Joseph Torti, III, Deputy Director and Superintendent
of Insurance
Rhode Island Department of Business Regulation
Insurance Division
1511 Pontiac Avenue, Bldg 69-2
Cranston, RI 02920
South Carolina
Scott H. Richardson, Director
South Carolina Department of Insurance
P.O. Box 100105
Columbia, SC 29202-3105
Office: 401.222.5466
Fax: 401.222.5475
Office: 803.737.6180
Fax: 803.737.6205
800.768.3467 (State Only)
300 Arbor Lake Drive, Suite 1200
Columbia, SC 29223
South Dakota
Merle Scheiber, Director
South Dakota Division of Insurance
Department of Revenue & Regulation
445 East Capitol Avenue, 1st Floor
Pierre, SD 57501-3185
Office: 605.773.3563
Fax: 605.773.5369
Tennessee
Leslie Newman, Commissioner
Tennessee Department of Commerce & Insurance
Davy Crockett Tower, 5th Floor
500 James Robertson Parkway
Nashville, TN 37243-0565
Texas
Mike Geeslin, Commissioner
Texas Department of Insurance
P.O. Box 149104
Austin, TX 78714-9104
Office: 615.741.2218
Fax: 615.532.6934
800.342.4029 (State Only)
Office: 512.463.6169
Fax: 512.475.2005
800.578.4677 (State Only)
333 Guadalupe Street
Austin, TX 78701
Utah
Neal T. Gooch, Commissioner
Utah Department of Insurance
3110 State Office Building
Salt Lake City, UT 84114-6901
Office: 801.538.3800
Fax: 801.538.3829
800.439.3805 (State Only)
136
For AGD Constituent Use Only
Vermont
Mike Bertrand, Commissioner
Vermont Division of Insurance
Department of Banking, Insurance & Securities
89 Main Street
Montpelier, VT 05620-3101
Virginia
Alfred W. Gross, Commissioner
State Corporation Commission
Bureau of Insurance
Commonwealth of Virginia
P.O. Box 1157
Richmond, VA 23218
Office: 802.828.3301
Fax: 802.828.3306
800.964.1784 (State Only)
Office: 804.371.9741
800.552.7945 (State Only)
877.310.6560 (Ombudsman
and Consumer Services—
Out-of-State)
Virginia Bureau of Insurance
State Corporation Commission
1300 East Main Street
Richmond, VA 23219
Virgin Islands
Gregory R. Francis
Lieutenant Governor/Commissioner
#18 Kongens Gade
Charlotte Amalie, St. Thomas, VI 00802-6487
Office: 340.774.7166
Fax: 340.774.9458
Division of Banking & Insurance
1131 King Street, Suite 101
Christiansted, St. Croix, VI 00820
Office: 340.773.6459
Fax: 340.719.3801
Washington
Mike Kreidler, Commissioner
Washington State Office of the Insurance Commissioner
P.O. Box 40256
Olympia, WA 98504-0256
Washington State Office of Insurance
Insurance 5000 Building
5000 Capitol Way Blvd., SE
Tumwater, WA 98501
137
Office; 360.725.7000
Fax: 360.586.2018
800.562.6900 (State Only)
For AGD Constituent Use Only
West Virginia
Jane L. Cline, Commissioner
West Virginia Department of Insurance
P.O. Box 50540
Charleston WV 25305-0540
Office: 304.558.3354
Fax: 304.558.4965
888.879.9842 (Consumer
Service Division-State Only)
State of West Virginia
1124 Smith Street
Charleston, WV 25301
Wisconsin
Sean Dilweg, Commissioner
Office of the Commissioner of Insurance
State of Wisconsin
P.O. Box 7873
Madison, WI 53707-7873
Office: 608.266.3585
Fax: 608.266.9935
800.236.8517 (State Only)
125 South Webster Street
Madison, WI 53703-3474
Wyoming
Ken Vines, Commissioner
Wyoming Department of Insurance
106 East 6th Avenue
Cheyenne, WY 82002-0440
Office: 307.777.7401
Fax: 307.777.2446
800.438.5768 (State Only)
American Samoa
Aoomalo Manupo Turituri, Commissioner
Office of the Governor
American Samoa Government
Pago Pago, American Samoa 96799
Office: 684.633.4116
Fax: 684.633.2269
Guam
John P. Camacho, Banking and Insurance Commissioner
Department of Revenue & Taxation Regulatory Division
P.O. Box 23607
Barrigada, Guam 96921
Building 13-3, 1st Floor
Mariner Avenue
Tiyan, Barrigada, Guam 96913
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Office: 671.635.1817
Fax: 671.472.2643
For AGD Constituent Use Only
Mariana Islands
Michael Ada, Commissioner
Commonwealth of the N. Mariana Islands
Department of Commerce
Office of the Insurance Commissioner
Caller Box 10007 CK
Saipan, MP 96950
Office: 670.664.3064
*Source: Home page of the National Association of Insurance Commissioners (accessed
August 30, 2010)
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For AGD Constituent Use Only
MedWatch:
The Food and Drug Administration’s MedWatch program was formally launched in June 1993.
It solicits reports from health professionals about serious and adverse events that occur through
the use of medical devices, prescription and over-the-counter drugs and other FDA-regulated
products. The agency defines an adverse event as “any undesirable experience associated with
the use of a medical product in a patient” and considers an event to be serious when the outcome
is: death, congenital anomaly, or requires intervention to prevent permanent impairment or
damage. Reports to MedWatch are confidential, and health care providers are not required to
present proof when reporting an adverse incident or problem product.
The AGD has joined the ADA, American Medical Association, and more than 50 other
organizations as an FDA MedWatch Partner. As a MedWatch Partner, we inform our members
about this program and to motivate them to play a role in postmarket surveillance.
As of February 1994, 65 percent of all MedWatch reports were about an adverse drug event, 20
percent regarded medical devices, 11 percent a drug quality problem, four percent were biologic
and one percent related to food. One percent of all individuals reporting to MedWatch were
dentists.
You may request a form for reporting adverse events by either mail or fax to:
MedWatch
5600 Fishers Lane, HFD-200
Rockville, MD 20857
800.332.1088
Fax: 800.332.0178
www.fda.gov/medwatch/report/hcp.htm
Food and Drug Administration
5600 Fishers Lane
Rockville, MD 20857-0001
888.463.6332
www.fda.gov
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For AGD Constituent Use Only
Federal Agency Contact Names and Addresses:
Because of the active role that the AGD is taking in access to care issues, a constituent president
may need to make contact with representatives of HHS agencies. To maintain open lines of
communications, we must know how to contact our counterparts in other professional
associations and government agencies. A list of the HHS agencies and their missions.
Centers for Disease Control and Prevention—Division of Oral Health—The CDC is the
federal agency with primary responsibility for community-based programs aimed at preventing
oral disease and promoting oral health, and for applied research to enhance oral disease
prevention. The DOH takes the lead for these activities through four main approaches:
monitoring oral diseases, promoting effective prevention strategies, building capacity within
state and local health infrastructures, and guiding infection control in dentistry.
Centers for Medicare & Medicaid Services (CMS)—formerly the Health Care Financing
Administration (HCFA)—administers the Medicare and Medicaid programs, which provide
health care to America’s aged and indigent populations, about one in every four Americans,
including nearly 18 million children and nursing home coverage for low-income elderly. The
CMS also administers the new Children’s Health Insurance Program through approved state
plans that cover more than 2.2 million children.
Health Resources and Services Administration (HRSA) helps provide health resources for
medically underserved populations. HRSA supports a nationwide network of 643 community
and migrant health centers, and 144 primary care programs for the homeless and residents of
public housing, serving 8.1 million Americans each year. HRSA also works to build the health
care workforce and maintains the National Health Service Corps, oversees the nation’s organ
transplantation system, works to decrease infant mortality and improve child health and provides
services to people with AIDS through the Ryan White CARE Act programs.
National Institutes of Health—National Institute of Dental and Craniofacial Research
(NIH/NIDCR)—The mission of the National Institute of Dental and Craniofacial Research
(NIDCR) is to the promote the general health of the American people by improving their oral,
dental and craniofacial health. Through nurturing fundamental research and the development of
researchers, the NIDCR aims to promote health, to prevent diseases and conditions, and to
develop new diagnostics and therapeutics. Knowledge acquisition through science and effective
and efficient science transfer are the means used to contribute to improved quality of health.
Interprofessional Relations:
As access to care issues emerge at the forefront, many organizations other than the AGD will be
involved in alleviating lapses in patient care. Recent legislative actions are opening caries
prevention modalities that once were the sole purview of dentistry. Some states are allowing
compensation by Medicaid for fluoride varnishes placed by pediatricians. Other states are
expanding the role of dental auxiliaries by loosening the supervision requirements by dentists. A
partial listing of professional contacts follows:
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For AGD Constituent Use Only

The American Academy of Pediatrics (AAP)—The mission of the AAP is to attain optimal
physical, mental, and social health and well being for all infants, children, adolescents, and
young adults. To this purpose, the AAP and its members dedicate their efforts and resources.
The American Academy of Pediatrics
141 Northwest Point Boulevard
Elk Grove Village, IL 60007-1098
847.434.4000

American Academy of Pediatric Dentistry (AAPD)—The AAPD is dedicated to
improving and maintaining the oral health of infants, children, adolescents, and persons with
special health care needs.
American Academy of Pediatric Dentistry
211 East Chicago Avenue, Suite 1700
Chicago, IL 60611-2637
312.337.2169

The American Dental Association (ADA)—The ADA is the professional association of
dentists committed to the public’s oral health, ethics, science and professional advancement;
leading a unified profession through initiatives in advocacy, education, research, and the
development of standards.
American Dental Association
211 East Chicago Avenue
Chicago, IL 60611
312.440.2500
Emergency Preparedness:
In light of the occurrences of September 11, 2001, dental organizations and individual dentists
have become more interested in the field of emergency preparedness. With proper training,
dentists can be valuable adjuncts in emergency medical care, mass casualty management,
forensic identification of victims, or many other fields.
Constituents can organize and offer emergency preparedness training sessions. Individual
dentists can become involved in local and national efforts. Again, using the Internet, many
valuable sources for information on emergency preparedness can be found by going to a web
browser as above and typing “Emergency Preparedness.”
Examples of some Web sites found are listed as follows:
http://www.phe.gov/preparedness/pages/default.aspx - Home page of the U.S. Department of
Health and Human Services, Office of Emergency Preparedness (OEP)
http://www.fema.gov/ —Home page of the U.S. Federal Emergency Management Agency
(FEMA)
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For AGD Constituent Use Only
http://www.bt.cdc.gov/ —CDC page for Public Health Emergency Preparedness and Response
In addition, many state and local groups have Web sites to be explored. Involvement of
constituents or individual members is limited only by comfort levels and depth of training.
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