For all our ortho friends out there, we recently heard about a new wrinkle developing in some Flexible Spending Plans and Health Savings Accounts. We wanted you to have some time to think about this before you get hit with a question in a consult, or worse yet, start treatment only to find out the patient has lost his source of financing. We’re hearing that some of the plans have started asking for a Letter of Medical Necessity from the orthodontist because they don’t cover cosmetic procedures. Before someone who understands their plan asks you the question in the consult “Will you write me a letter of medical necessity?” You need to consider where you will draw the line. In discussing this here at Mosaic, we can always push even one crooked tooth to the point where it MIGHT develop periodontal issues if not properly flossed and COULD be lost and not replaced which COULD let the bite drift and cause issues with chewing and eating and thus be medically necessary. That being said, you need to decide how far you’re willing to extrapolate before putting your signature on such a letter.
We also now need to suggest our treatment coordinators ask if parents or patients plan to use a flex plan or HSA. They then need to have the patient check the requirements for orthodontics so we don’t get a patient bonded only to have the responsible party get a letter a few weeks later asking for either the money back or a letter of medical necessity. That’s not the point to make the decision if the procedure is or isn’t medically necessary. We need to expect these types of issues will come up with a great deal more frequency as companies get squeezed harder and harder by government rules and bills. Whatever your politics might be, you have to realize these companies will not allow their profit margins to drop, so the changes will continue to trickle down to the patients. Like it or not, we need to consider how we’ll handle these changes.
