Don’t assume that all teledentistry treatment is covered under your malpractice insurance, including any work performed for a DTC company, says the AAO.

By Greg Thompson

It’s well known that the steady rise of direct-to-consumer (DTC) orthodontic care over the last decade has raised concerns among clinicians and advocates for the profession. At the most basic level, many feared that DTC practices would undercut business and negatively affect orthodontists’ bottom line. While that fear has mostly gone away in light of advertising campaigns that raised the profile of orthodontic treatment, there are still concerns about quality of care.

One step down on the worry ladder is liability. In an undeniably litigious society, malpractice insurance remains a crucial safeguard to blunt the potential financial harm of lawsuits. Orthodontists who examine every clinical detail in an effort to help patients would do well to put that same diligence to work and read the malpractice fine print, particularly in a world where DTC relationships continue to expand.

The American Association of Orthodontists (AAO) rebooted those malpractice concerns with a March 2021 article stating: It is possible that, by consulting with and/or providing diagnoses and treatment plans for a direct-to-consumer orthodontic company, you may not be in compliance with the Conditions of Coverage of your malpractice insurance. Your policy may state that orthodontists must have a doctor-patient relationship in order to have coverage.

As one example, AAOIC coverage applies to an orthodontic incident “only if the insured has performed a comprehensive examination of the patient, has obtained and studied appropriate diagnostic records on which any resulting diagnosis, treatment plan or treatment recommendation is based, and has monitored the patient’s progress regularly or reasonably attempted to do so.”

What does it cover?

Before his term ended the last week of April, now-former AAO President Chris Roberts, DDS, MS, confirmed that the AAO does not have control over requirements put in place by malpractice insurance carriers for their insureds, including requirements for coverage of treatment through teledentistry. “Having said that, the AAO is aware that malpractice insurance carriers may not cover ‘DTC’ or other treatment provided through teledentistry if providers do not follow certain prerequisites,” Roberts warns. “For instance, the AAO understands that many malpractice insurance policies require a doctor-patient relationship, including an in-person examination of the patient, prior to orthodontic treatment. The AAO recently published a notice to its members alerting them to this issue.”

Roberts acknowledges that some practitioners assume that all teledentistry treatment is covered under their malpractice insurance, including any work performed for a DTC company, while other practitioners may think that no treatment through teledentistry is covered. “The AAO encourages all orthodontic practitioners to contact their insurance carrier to determine the level of coverage for any teledentistry-based treatment,” says Roberts, who also serves as an adjunct clinical professor of dentistry at the University of Michigan. “As noted in the resource the AAO recently published for its members, malpractice insurance likely covers a great deal of teledentistry treatment, although DTC treatment may not be covered if certain prerequisites, such as an in-person examination, are not included.”

One and done is not enough

For its part, the AAO supports increased access to dental care via teledentistry if it is provided in the best interest of patients’ health and safety, and complies with other laws. The AAO’s Legal and Advocacy Department put together a six-part list of teledentistry paramaters, putting “in person examination/evaluation” at the top of the list.

And yet, the idea that a “one and done” evaluation is enough to satisfy insurance carriers and/or quality of care concerns, is not the message conveyed by Roberts and others. Roberts confirmed with Orthodontic Products that a comprehensive clinical approach is indeed a multi-pronged effort.

“As an organization whose goal is to protect the health and safety of all orthodontic patients, the AAO has serious concerns about orthodontic treatment incorporating the use of teledentistry without other key elements,” Roberts stresses. “Before patients receive treatment, they should understand that comprehensive radiographs are essential to the development of an accurate diagnosis and treatment plan.

“Additionally, patients should be aware that supervised visits with an orthodontist play an integral role in the treatment’s success,” he continues. “If a problem arises, patients need to feel comfortable asking their orthodontist questions about their overall treatment. Ultimately, if an orthodontist has not established a doctor-patient relationship by examining and diagnosing a patient before treatment begins, the patient’s health and safety may be at risk.”

Concerns Remain

Roberts confirms that the AAO still has “serious concerns” about any DTC treatment or other orthodontic treatment administered in a manner where the AAO’s recommended teledentistry parameters are not followed. “We advocate at the state and federal level for statutes and regulations that will best protect orthodontic patients,” he adds. “For example, orthodontic treatment’s safety and efficacy are highly dependent on conditions below the gum line, which are not visible without radiographic imaging. The AAO strongly supports statutes and regulations that require that radiographic images be taken before orthodontic treatment begins.” OP