The Guardian Life Insurance Company of America has reversed its position on third molars and associated sedation and anesthesia, now assuring dentists that claims will no longer be reviewed for medical necessity.
According to Guardian’s website, Guardian has more than 114,000 in-network dentists in over 330,000 locations.
Dr. Randy S. Tillman, Guardian’s assistant vice president and chief dental officer, wrote, “We made updates to Guardian’s clinical policies that we thought would better align our claims practices with the marketplace and clinical norms.
“Soon after that change was implemented, the feedback we received from our customers and professional community was that the new medical necessity review process did not align with customer expectations,” she told the ADA News in a statement.
“Therefore, effective immediately we will no longer apply medical necessity review criteria to third molars and associated IV sedation or general anesthesia.”
Oral surgeons for whom Guardian has mailing addresses will receive postcards with this information, Dr. Tillman said. She added that it is not necessary for dentists or patients to resubmit denied claims, as Guardian will automatically reprocess any denied claims retroactive to April 26 within 45 days.
“The positive feedback we’ve received, to date, reinforces how much value Guardian places in listening to our customers and the professional dental community,” Dr. Tillman told the ADA News.
“This is just another example of the ADA advocating on behalf of all dentists nationwide,” said Dr. Steve Snyder, chair of the ADA Council on Dental Benefit Programs.
Visit the ADA Center for Professional Success at
Success.ADA.org and search for “Third Party Payer Advocacy” for more information on member support for third party issues.