Florida Combined Life drops policy limiting same-day scaling and root planing following ADA advocacy

Plan denied 2 of 4 quadrants from dentist’s claim

Florida Combined Life is dropping its policy that limited same-day scaling and root planing to only two quadrants after the American Dental Association’s Council on Dental Benefit Programs reached out to the plan with concerns.

A dentist had submitted a claim to Florida Combined Life for four quadrants of scaling and root planing on the same date using code D4341 periodontal scaling and root planing — four or more teeth per quadrant. The plan paid for two quadrants and denied the other two quadrants, stating no more than two quadrants of periodontal services are eligible on the same date based on the patient’s dental contract.

“Some patients choose to have all four quadrants of scaling and root planing done in one visit for convenience, comfort and a faster return to a healthy mouth,” said Bertram Hughes, D.M.D., vice chair of the ADA Council on Dental Benefit Programs. “Completing treatment in a single day means fewer appointments, one round of anesthesia and a fresh start. This approach can also be especially helpful for patients who travel long distances or want to minimize disruptions to work and family schedules.”

After ADA staff presented the council’s concerns, Florida Combined Life reversed its decision on the dentist’s claim and said it would be dropping this policy altogether. Four quads of scaling and root planing on the same date of service will no longer result in two of the quads automatically being denied.

“There seems to be a common trend of denying services on claims rather than requesting additional documentation, putting the responsibility on the dental office to start the appeals process,” Dr. Hughes said. “The ADA highly recommends that dentists appeal an adverse decision with the dental plan if it appears a claim was not properly adjudicated. We appreciate Florida Combined Life listening to this concern and helping to find a resolution, and we look forward to other payers following this example.”

For more information and resources related to dental insurance, including a guide on how to file a proper appeal and an archived webinar and educational guides on scaling and root planing claim submissions, visit ADA.org/dentalinsurance.