Situation Report: A complex dental claim

The Situation: A client sent us a claim for a long fixed bridge. X-rays revealed the presence of significant bone loss, particularly on a tooth that was to support the bridge.

The Challenge: To provide the most appropriate benefit

Action Taken: We contacted the dentist who agreed to have the patient seen by a gum specialist.

The Results: The gum specialist determined that the supporting tooth was not treatable, and that if used, would have shortly failed. The dentist then agreed that a removable partial denture was the most clinically appropriate service for this patient. The patient was spared unnecessary discomfort and expense, the dentist avoided potential liability, and the plan saved money on a less expensive treatment.

Contact us for more information about our claims review services.

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