Council on Orthodontic Health Care
Dr. Stephen Robirds
The COHC is charged with three main responsibilities:
- Consult and interact with appropriate organizations concerned with the provision of orthodontic health care;
- Study and make recommendations on all matters concerning reimbursement plans that are related to orthodontic care; and
- Study and make recommendations to improve the oral health care of the public by expanding access to quality orthodontic care.
The council has met twice since the last ad interim board meeting. At the meeting in July of 2006, four representatives from various payer organizations met with the council to discuss the current codes assigned to orthodontic health care. The payers were requesting more codes to represent different aspects of treatment. With better record keeping, then the payers feel they can increase their coverage for individual treatment. The council felt that additional tracking by the individual orthodontists would be more cumbersome for filing claims. Electronic claim filing would simplify that, and the payers said that 45% of all claims are submitted electronically now. The payers agreed to submit a position paper on code proposals for review by the BOT by their November board meeting.
One question posed to the Payers was about the viability of Health Saving Accounts. They said that most employees prefer not to make their own decisions regarding their health, but rather leave it up to their employers-a curious observation. All agreed it was helpful to all to meet and discuss these insurance issues, and more meetings will be planned in the future.
At the January 2007 meeting, the bulk of the time was spent with the access to care issue. Representatives from the Virginia Brown Foundation gave a presentation and answered questions on their Smiles Change Lives (SCL) programs. There appears to be two main access to care issues- access to care from a financial standpoint, which the SCL program addresses, and from a location (i.e. rural) standpoint. The council will try to get the video presentation from the Virginia Brown Foundation to show to the constituent boards to encourage more regional access to this program. As far as access to care by location, it was felt that primary dental care was essential and orthodontics can come later.
The AAO member hotline has been seeing an increase in usage over the past year. The majority of the calls dealt with CDT coding questions and issues surrounding the National Provider Identifier (NPI) numbers.
With regards to orthodontic codes, there was agreement to streamline the codes, but add in codes for temporary anchorage devices and cone beam imaging. The overall effect would be to not increase the number of orthodontically related codes, but make them more representative of what we need in our profession for filing. Various members of the council will be attending meetings in different parts of the country, in the year ahead, related to working on the insurance codes with both the insurance industry and the ADA.