The process of insurance authorization and payments can be challenging both for the dental office and patients. Denial of claims is all too often a response from an insurance company, and the question is, how do we get more acceptances for our procedures? Seeing is believing, and comprehensive imaging — X-ray, camera, and more — can be the key to achieving coverage. For one of Dr. Lou Graham’s patients, a CariVu™ image helped to change a denial to acceptance. CariVu, the transillumination technology caries detection device, can be used to identify occlusal, interproximal and recurrent carious lesions and cracks, even at the beginning stages.
The patient, a woman in her 60s, came to Dr. Graham’s office with pain in tooth No. 18. The bitewing and periapical X-rays showed no overt caries or cracks, but testing with a Tooth Slooth® resulted in sensitivity on the tooth’s distal lingual cusp. Dr. Graham informed the patient that in all likelihood the tooth had a significant crack and used the term “cracked tooth syndrome” to further substantiate the reason for immediate treatment. Routinely, this clinical problem does not show up on X-rays for a variety of reasons.
After removing the old amalgam, Dr. Graham took another intraoral image along with a CariVu image. He said that the CariVu image “distinctly showed a crack running from the distal surface of the tooth traversing the distal lingual cusp and exiting the lingual surface of the tooth.” The patient subsequently had a crown buildup and crown performed, and routine insurance communication (letter with images of X-rays of the area, bitewing and periapical) from his office was forwarded to the insurance carrier.
Within weeks the “denial” of coverage for the cracked tooth procedure was received by his office as the insurance company claimed a crown was not deemed necessary. After that, Dr, Graham forwarded a subsequent letter with CariVu and intraoral images that more clearly showed the fractured area and demonstrated to the insurance company, with clear visual evidence, that a crown was needed to save the tooth. Dr. Graham believes that the intraoral images and the CariVu led to the original denial being reversed, and the patient was paid her portion.
Dr. Graham routinely takes a CariVu image or images for documentation when appropriate to further substantiate his diagnosis and course of treatment to the insurance company. He equally notes the technology allows both himself and his team to present the images to the patient and ultimately enhance communication. He explains, “The technology truly enhances interproximal caries diagnostics along with evaluating cracks and more. Whether we do a composite, or a crown, or actually monitor a situation, CariVu has become an essential technology for our office. If the patient has future sensitivity or requires additional treatment beyond a composite or a crown, the images are an excellent reference to have documented in the patient’s digital file.”
Dr. Graham notes his patients love radiation-alternative diagnostics, and he believes this type of technology enhances the patient’s view of the practice. He looks back on the day that CariVu provided the documentation around his course of treatment that helped change the insurance claim from no to yes. Dr. Graham noted, “That day, I received a big thank you from one happy patient.”
You, too, can add CariVu to your imaging armamentarium! Contact us today at 888-883-3947.
Indications for use: www.dexis.com/ifu