Dentaltown December 2019 - 39

OP, you have correctly identified the true reason for "additional documentation" like GM
info. ■

Herodontist 80111
Member Since: 09/22/17
Post: 31 of 58

8/17/2019

I am 100% convinced that UCC will deny any perio on anyone younger than 40. I don't
care what you submit, what the measurements are or what the X-rays show ... under age 40 is
a denial. ■

moptop
Member Since: 03/11/10
Post: 32 of 58

8/17/2019

I tend to agree. The comments in this thread have focused on the need to measure GM,
but GM/CAL was never mentioned by United Concordia as the reason for denial. I've gotten
requests from other insurance companies wanting GM/CAL before they would process the
claim, but United Concordia just outright denied the claim, stating it did not meet their criteria
for needing SRP without any further elaboration. ■

jcr87
Member Since: 04/04/06
Post: 33 of 58

8/17/2019

Do you really think the insurance company is going to tell you exactly how to more easily
get money out of them? Yes, UC is worse than many at getting paid on anything. However, I
can tell you I get them to pay all the time-crowns, SRP, etc. Over 300 of each, every year, and
I might have one or two not pay.
And do realize that "not meeting criteria" can mean a lot of things, but it almost always
means "you did not submit the correct information to get paid." ■

Practice Whisperer
Member Since: 07/22/11
Post: 34 of 58

8/17/2019

Just wondering? If the gingival margin is at the CEJ and there has been previous disease
activity such as previous early bone loss, could there not be a 5mm probing depth that was
related to 2mm of current gingival overgrowth due to current gingival inflammation that represents a pseudopocket? This could be treated with scaling and OHI. As opposed to a situation
where the gingival margin is at the CEJ and there is no gingival overgrowth and a true 5mm
probing depth. Like in this case, there has been further bone loss than the first example, and
this case would require SRP?
Apologies if I am missing something here. How does that situation relate to the CEJ and
gingival margin recording system? In the U.K. here, do not work with an insurance company,
but just wish to clarify. ■

JonHenley
Member Since: 12/18/10
Post: 35 of 58

8/23/2019

The problem comes in when you say you have a 4-5mm pocket, but don't mark gingival
margins. Therefore it can be assumed (correctly or not) that the GM is a -2, which now makes
that pocket in actuality a 2-3mm CAL, which would not indicate the need for SRP. At least in
the U.S., 4-5mm CAL is required for SRP, not 4-5mm of pocket depths. ■

Practice Whisperer
Member Since: 07/22/11
Post: 37 of 58

8/23/2019

What!?!? I know the periodontitis classifications recently changed, but 1-2mm CAL is early
periodontitis (now Stage 1, I believe); 3-4mm CAL is moderate periodontitis (now Stage 2); and
> 5mm CAL is severe periodontitis (now Stage 3).
Any CAL is a history of periodontitis or active periodontitis, which (Grade 2 and Grade 3)
requires SRP. Also, in my PM software perio charting, if the gingival margin is coronal to the
CEJ (no recession or zero recession), no number is recorded-not even a zero. ■

iahawkeyedds
Member Since: 07/17/08
Post: 38 of 58

8/24/2019

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Dentaltown December 2019

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