Criteria for case acceptance:
- The dentist whom the complaint is against must be a MDDS member
- The case must concern itself with quality of care and appropriateness of treatment
- The date of discovery must be within two years
Cases not accepted for peer review:
- Complaints involving dentists who are not members of the MDDS
- Complaints of poor customer service, practice management or fees
- Complaints concerning a staff member’s behavior
- Complaints in which a lawsuit has been filed. An exception to this condition is the instance in which a dentist has initiated litigation for the collection of a fee.
- Complaints in which the CDA Council on Peer Review finds that the case has been reviewed or is currently in review by the State Board of Dental Examiners, other state peer review committees, third party carriers or managed care review bodies.
Things to remember about peer review:
1. The dentists who work with peer review receive no pay for their time and efforts. They are all trained volunteers and as such, they are expected to conduct fair and impartial mediations.
2. If your case is accepted for peer review, this does not mean the Committee is convinced that your dentist has done something wrong. The decision to accept a case is based only on the information reported by the patient. Accepting a case allows the process to get started.
3. The peer review process may result in your dentist giving you a refund of some or all of the fees paid for a specific treatment. No money above this amount will be paid as part of the peer review process. If a dentist does agree to refund some or all of the fees paid, this is not an admission of guilt and should not be construed as such.
4. An unexpected or bad result of a dental procedure does not necessarily mean the treatment was done poorly or inappropriately planned. The human body is not always predictable.
5. The most you can be refunded through peer review is the original fee you paid. Peer review does not allow payment for pain, suffering, inconvenience, or work performed by another dentist. Monies paid to an insurance carrier are generally returned to that carrier unless the patient is no longer with that provider.