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SRP recommendation

my office told me to be careful of recommending SRPS with no radiographic calculus. i had 2 pts which were denied by the (good) insurance. those two patients who havent had cleaning in about 10 years, have beginning and moderate boneloss. lots of bleeding and hvy plaque and gen supra calc with generalized 4-6mm pockets. it was suggested that we do alternative treatments such as prophy with full mouth irrigation and/or arestin (lottts of arestin). im conflicted. im more like unsure if were supposed to go with the reality of the business and think about which type of insurance are strict or not before even recommending the right treatment. has anyone dealt with this problem before? if so, what do you do?i mean, were just clinicians recommending whats best for the patient right?



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Without seeing these patients clinically myself and by just going off your description I would agree they would benefit more from SRPs than the “alternative treatments” recommended. If SRPs are denied I would re-submit the claim with a narrative including the signs of the patient’s disease AND contributing factors – diabetes, smoking, etc. Radiographic calculus doesn’t determine whether disease is present! You are totally right in that we treat the person and the disease, not what the insurance dictates. You need to treat the patient based on your professional expertise and not what “the office” (and I’m going to make a leap here and say that whomever said this may not be a licensed dental professional) dictates because they are looking to make a quick or easy buck. Go with your training and your gut, it tends to be right!

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