Denis Chairside Guide 2006 and Guide to the Discovery Health Rate 2006

Astute members will have noticed that on the cover of the Guide to the Discovery Health Rate 2006 the phrase “Published by the South African Dental Association” appears. This information is incorrect and, on writing to Discovery Health, an apology was received from their management. I refer you to the first page of the SADA Codes and Terminologies where it states “Both Discovery and Denis benefits schedules are included (in this package). This inclusion in no way implies that SADA endorses either publication nor the benefits contained therein. The funder booklets are merely included for the convenience of our members…”.

SADA wishes to apologise most sincerely to Denis for allowing this unfair and erroneous information to be printed. SADA did not publish or print either publication but merely distributed both publications. We are grateful to both Denis and Discovery for assisting financially with the mailings costs involved.

Complaints about Medical Schemes refusing to authorise General Anaesthetics for dental treatment

At a recent meeting of the SADA Private Practice Committee concern was voiced that medical schemes were refusing authorisation for hospitalisation  and general anaesthetic (GA) administration for their members for dental treatment. Mention was made that the dentists spend inordinately lengthy periods on the phone attempting to obtain such authorisation, usually without success.

Older members of the Committee pointed out that no dentist should assume the responsibility of obtaining authorisation for GAs from any scheme, as this responsibility is the sole responsibility of the patient. Dentists should provide their patients with a treatment plan, quotation and motivation for providing the treatment in hospital under GA. From that point on the patient has the responsibility of obtaining the necessary authorisation – not the dentist.
It is interesting to note that colleagues following this route have no demands on their time and a greater number of their patients receive the necessary authorisation. This is because the schemes are far more inclined to grant the necessary authorisation to a member who is being ‘stroppy’ than to a dentist. This is especially true when the member approaches his or her company’s medical scheme liaison officer who threatens to leave the scheme together with the large number of employees represented by that officer, unless the necessary authorisation is forthcoming.

In the days when there was guaranteed payment by schemes for work rendered by dentists at the then ‘contracted-in’ rate, it made some sense for the dentist to become embroiled in the thankless task of obtaining authorisation on behalf of his or her medical scheme patients. In today’s totally different situation it is absurdly illogical for dentists to assume responsibility for fighting the patients’ battles with their medical schemes (certainly for elective non-emergency procedures) when there is no guarantee of any favourable outcome for the dentist.

 The altruists amongst us will immediately state that the patient does not have the clinical knowledge to fight these battles, which is true. From the funders’ point of view, however, this is seldom a clinical decision, with the vast majority of authorisations being decided on financial grounds with no thought for the mental well-being of either the patient or dentist. The totally arbitrary rules which state that a child of 5 years 11 months and 30 days requires a GA for dental treatment whereas the same child a couple of days later at 6 years and 1 day can sit in the chair for the same treatment, bears testimony to the schemes placing financial priorities over sound clinical judgement.

The Private Practice Committee challenges all SADA members to pass the responsibility back to the patient/guardian. The patients we have spoilt by fighting their funding battles by proxy need to know that it is they who have a contract with their scheme – not the dentist. I am convinced that you will not be disappointed with the results of this action. ~