Industry News

ADA and two dentists sue Aetna
The American Dental Association and two dentists are suing Aetna Inc., the third-largest provider of U.S. dental health insurance, for not paying the full amount for service and for libeling dentists outside of its network. The lawsuit seeks relief under the Employee Retirement Income Security Act, also known as ERISA.

In the lawsuit, the ADA has accused Aetna of regularly breaching its contract with subscribers by failing to pay non-plan providers’ actual charges for professional services rendered and for interfering with the dentist-patient relationship.

The dentists, Dr. James Swanson, who has a dental practice in Palos Heights, IL and Dr. Michael Dayoub, a periodontist in Savannah, Ga., are seeking unspecified compensatory and punitive damages and an injunction prohibiting the company from continuing these alleged practices. Dayoub was paid $264 by Aetna for bone-replacement grafts for which he charged $675 and Swanson was paid $42 for comprehensive oral examinations, less than his standard fee of $47.

Aetna’s contract with its subscribers states the insurer is required to pay out-of-network providers’ actual charges unless it has appropriate data to substantiate a lower payment, according to the lawsuit. The lawsuit claims Aetna did not substantiate the lower payments and misrepresented how it arrived at determining usual, customary and reasonable, or UCR, amounts it paid to out-of-network providers. The complaint says Aetna knew or had reason to know the lower amounts it paid were below proper payment levels.

The lawsuit also accuses Aetna of using language on its Explanation of Benefits (EOB) form, which is sent to patients, to tell patients of the out-of-network dental provider that it would not pay the dentists’ actual charges because the provider has engaged in misconduct by attempting to charge excessive and unreasonable fees. Dr. Robert Anderton, president of the ADA, said in a statement: “By deliberately disseminating misinformation about individual dentists and their fees, we believe Aetna has seriously undermined the trust between dentists and their patients by casting doubt on their integrity and professionalism.”

Aetna, which has about 13.9 million dental customers, also faces federal lawsuits by physicians and patients who allege the company routinely paid medical claims slowly or misled patients by not telling them doctors got incentives to limit care. The company faces similar suits by doctors in Connecticut and New York.

Kodak to discontinue Ektaspeed-Plus
With the outstanding success of its latest intraoral xray film, Insight, Eastman Kodak, has decided to discontinue their Ektaspeed Plus film at the end of this year. The film will be discontinued when supplies of current stock are depleted.

“The enthusiastic response from dentists to our new Kodak InSight Film has been tremendous,” said Ruth K. Arbuckle, worldwide analog imaging product line manager, Kodak dental business. “Dentists love the image quality and the reduced radiation exposure.”

Kodak’s InSight Film was launched in 2000 and over 90 million packets have been sold worldwide since that time. Compared to the company’s Ektaspeed Plus Film, an E-Speed film, dentists can lower their radiation exposure times by as much as 60%. Reduction in exposure times is the only change needed to convert to the new Kodak InSight Film. No other changes in exposure technique are required.

CollaGenex Pharmaceuticals launches multivitamin formulated to promote oral health
CollaGenex Pharmaceuticals, Inc. has announced the availability of Dentaplex, a professionally recommended nutritional supplement specifically formulated to help maintain optimal oral health. The new supplement's formulation is built on a "C-complex" of calcium, vitamin C and carotene, the group of vitamins and minerals closely associated with healthy gums and strong teeth. Dentaplex will be available for sale in pharmacies, food and mass merchandise stores.