Most patients don’t understand the different x-rays we might use to look for problems at your checkups. Usually, we will use bitewing x-rays during a checkup, which give us a good overall picture of your full dental arches above and below. But they don’t always give us a detailed view of specific regions. Periapical x-rays focus on just one or a few teeth and are oriented to show the entire tooth, from its crown to down below its root. They show us problems around the tooth root that are hard to see on normal bitewing x-rays.

The ADA Opposes the Change

The first announcements of the policy changes nationwide began in June, and went into effect in mid-August, though the company had begun implementing the changes on a state-by-state basis in 2013. The new policy is that the company will not cover any periapical x-rays that are taken without a specific complaint of symptoms from a patient. In the absence of these symptoms, the insurance company would not pay for the x-rays, nor allow the dentist to bill the patient for them. In order to get coverage for the patient x-rays, the dentists would have to submit the actual x-rays, along with a description of the reported symptoms. In response to the recent policy changes, the American Dental Association (ADA) has stated that this change in coverage is unnecessary and can potentially cause patients harm. The documentation requirements, the ADA says, are strenuous and unnecessary. In response, United Concordia notes that it was originally not going to cover any periapical x-rays, but has decided to cover some that include adequate documentation.

Our Experience Shows the Policy Is Risky

Needed XrayAlthough the insurance company may argue that its policy it and its policyholders from unnecessary x-rays, our experience shows that sometimes x-rays need to be taken even when there are no obvious symptoms. In the case of this periapical x-ray, the patient didn’t report any symptoms, and there was no visible problem, but the x-ray showed different. It looked like the two center teeth were dead and that the neighboring teeth were in danger, too. We tested the center teeth with cold to determine whether there was any nerve response. When there was no response, we decided the teeth were probably dead, which was confirmed when we performed root canals on them and found only non-vital tissue. This is a case where the supposedly “unnecessary” x-rays allowed us to detect tooth problems before there were painful symptoms and save two, possibly four teeth. We are still committed to working with you and your insurance company, but it’s important to understand how your insurance company might prevent us from giving you the best care. Make sure your insurer understands that quality of care matters to you. If you are looking for a Philadelphia dentist who is also committed to the best care, please call (610) 272-0828 today for an appointment at Dental Excellence of Blue Bell.