AAO Contacts Delta Dental Affiliates Nationwide about Virginia Affiliate’s In-Person Evaluation Requirement for Orthodontic Treatment

AAO President Dr. John Callahan has sent a letter to Delta Dental state affiliates across the nation, expressing support for a policy recently adopted by Delta Dental of Virginia (DDVA). The policy requires an in-person examination and radiographs before any orthodontic treatment will be considered for insurance coverage.

DDVA’s new policy, effective July 1, 2024, requires an attestation by the treating orthodontist/dentist before submitting a claim for coverage of orthodontic treatment. The provider must attest that the patient has received an examination that conforms to the applicable standard of care; had their most recent diagnostic radiographs reviewed; and that the patient’s oral health is sufficient for beginning orthodontic treatment.

DDVA’s news release regarding the new policy specifically referenced in support the AAO’s guidelines, stating, “Whether treatment is provided in-person or virtually, Delta Dental requires that orthodontic care meet the same standards defined by the American Association of Orthodontists (AAO), including a clinical evaluation, diagnosis, and treatment plan.”

DDVA further noted, “This Attestation will help confirm that patients receive appropriate clinical oversight for their orthodontic treatment with the continued market emergence of Direct-to-Consumer (D2C) Orthodontics, where patients are instructed to perform self-evaluations independently, take their impressions, and order products, such as orthodontic aligners. Potential risks inherent in self-directed orthodontic care include not having had a thorough examination, diagnosis, and treatment plan. Additionally, self-directed appliances may not fit properly, causing permanent damage.”

Dr. Callahan’s letter to the other Delta Dental state affiliates informed them of the new DDVA policy, expressing the AAO’s “strong support (for) this recent policy change by Delta Dental of Virginia, believing it to be in the best interest of patients’ and insureds’ health and safety.” The letter encouraged other Delta Dental state affiliates to adopt a similar policy.