The purpose of the peer review system is to resolve disputes that may arise in the delivery of dental services to the public. The Metro Denver Dental Society (MDDS) conducts unbiased, objective and timely reviews utilizing the Colorado Dental Association’s (CDA) format for addressing disputes between patients, dental care providers and third-party carriers.
Peer review is not a court and has no disciplinary function. It merely provides an alternative dispute resolution mechanism, at no cost to either party. Peer review is a process by which the dental profession reviews and attempts to resolve dental treatment problems and misunderstandings through mediation. The MDDS Peer Review Committee consists of MDDS member dentists who volunteer their time to review and assist patients.
A peer review committee will initially attempt to mediate a problem. If necessary, an arbitration panel may meet to discuss the case, and may examine clinical records, talk to the patient and the dentist and, if necessary, arrange for a clinical examination. The dentist and the patient will be informed of the committee’s decision and recommendation for resolving the problem. Peer review is not a court of law, but a voluntary process that relies on the good faith between a dentist and patient and their mutual interest in good dental health. This service has proven most effective when the participants understand its purpose and limitations. The information listed below is to help you better understand peer review, avoid misunderstandings of the process and see how peer review can be of assistance in resolving your dispute.
Some dental complaints, while valid, are not suitable for peer review. Peer review deals with quality and appropriateness of care. Therefore, there is no guarantee that your case will be accepted for review.
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 Colorado Dental Board, 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 payment 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.
If you have questions about filing a complaint contact Marlene Pakish to this page – (303) 488-9700 or firstname.lastname@example.org
The Metro Denver Dental Society is a not-for-profit component society of the American Dental Association and the Colorado Dental Association.