Doctors: Does United Concordia Make You See RED?

March 30, 2000

Pennsylvania State Commission of Insurance
300 Liberty Way
304 State Office
Pittsburgh, PA 15222

Dear Sir or Madam:

In early February we received a letter from United Concordia indicating that we must pre-determine all treatment. Hence forward, our 22 year relationship has been altered.  As you can see from the attached, they are requiring that we pre-determine all treatment rendered in our office.  As I am sure you are aware The Children's Hospital and Jefferson Hospital are both terminating all arrangements with Pennsylvania Blue Shield as a result of their well-documented practice of delay and denial.

We have complied with United Concordia's mandates and have found that their claim examiners have not approved more than 85% of the treatment we have requested.

Until United Concordia can place a dentist in our office with an explorer in hand, binocular surgical magnification, and/or an intraoral camera they are in no position to ascertain the need for restoration we deem appropriate.  They can only review radiographs which are a dim, one-dimensional view of something which is three-dimensional.  They will not be able to see caries on the facial or lingual surface, nor broken fillings, on an x-ray.  This has forced us to inconvenience our patients, requiring them to return to our office for radiographs.  We have tried billing the insurance carrier for the cost of rendering these photos but, to date, they have not paid for any.

We are trying to maintain our relationships with our patients. United Concordia is trying to undo this trust by denying our claims.  

We formally would request that you that you mandate United Concordia to cease and desist from this unusual business practice.

Sincerely,

Dr. Stephen Markus

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