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What is Peer Review?
The Michigan Dental Association realizes that differences sometimes exist between the patient, dentist or dental insurance carrier. The MDA Peer Review Dental Care System is designed to assist patients, member dentists, and dental insurance companies resolve disputes when they are unable to do so on their own.
How is peer review helpful? Peer review:
- maintains high dental standards;
- aids in mediation efforts;
- meets the needs of the public regarding the quality and appropriateness of dental care; and
- assists parties in avoiding litigation.
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Q:
Who Can Initiate a Peer Review Complaint?
A patient, member dentist, dental insurance company, or state of Michigan agency may initiate a complaint.
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How is a Complaint Initiated?
The complainant obtains and completes a "Peer Review/Dental Care Information Form" and returns it to the Michigan Dental Association. Complaint forms are available by calling the Michigan Dental Association at (517) 372-9070.
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How Does Peer Review Work?
Upon receipt of your complaint form, the matter is referred to the local or specialty dental society peer review committee. The committee will first attempt mediation by contacting both parties and clarifying the issues. If mediation is not possible or is unsuccessful, a formal review will take place. All parties are contacted for an interview, which can take place over the telephone or in person, depending on the nature of the complaint. The committee may perform a clinical exam, if one is warranted or appropriate. When the committee makes a decision, all parties are notified in writing. If the committee orders a refund, the refund amount is limited to the amount that was actually paid to the dentist. However, during the mediation process, the patient and dentist may agree to an amount different than what was actually paid.
The Michigan Dental Association monitors each case's progress at the local/specialty level.
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Can the Decision of the Local/Specialty Peer Review Committee be Appealed?
Yes. Any party may appeal the decision to the Michigan Dental Association Committee on Peer Review/Dental Care. The committee may accept appeals to determine if proper procedures were not followed, and/or the decision contradicts the evidence presented.
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Is There a Fee for Peer Review?
No. Peer review is a free service provided by the Michigan Dental Association and the local/specialty dental societies.
If dental records (such as X-rays) need to be taken by the review committee in order to properly review the treatment in question, costs for these records may be charged to the patient.
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Q:
How Much Time Will Peer Review Take?
This is difficult to predict; it depends on the type of complaint and how cooperative all involved parties are. Also, the peer review system relies on volunteer dental reviewers who receive no remuneration for their services. These volunteers are taking time out of their personal and professional lives to serve on the peer review committees.
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Q:
Will the Complaint and Dental Records be Made Public?
No. The complaint and contents of all case files are kept in strict confidence. Decisions of the Michigan Dental Association Peer Review System are confidential (MCLA 331.531, et. seq.). Neither the patient nor the member dentist is entitled to a copy of the complete case file.
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Q:
What if the Complaint is Against a Nonmember Dentist?
The peer review system is not available to nonmember dentists. If the complaint involves a nonmember, the complainant is so informed and provided with a referral to the state of Michigan complaint and allegation division.
Nonmembers are not held to an ethical code; members of the Michigan Dental Association are. Thus, members are obligated to cooperate with the process and comply with peer review decisions. For these reasons, it is recommended that patients see a Michigan Dental Association member-dentist.
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How Does the Peer Review System Operate if the Complainant Now Resides Out-Of-State
The complaint is initiated as normal. If a clinical exam is required and the complainant cannot return to Michigan for the exam, the Michigan Dental Association will request assistance from dental association in the state in which the complainant resides.
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Q:
Does Peer Review allow releases?
Anytime during the peer review process, but prior to a decision being published, the dentist may request that the patient sign a release. The Michigan Dental Association cannot obligate the patient to sign the requested release. The peer review process proceeds to conclusion regardless of whether or not a requested release is signed.
Dentists may develop the release instrument on their own, or they may request that their professional liability insurer assist them. The Michigan Dental Association will not provide either a specific or sample release.
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Where Do I Find More Information?
To discuss the Michigan Dental Association Peer Review Dental Care System, contact Lisa Boettger, senior professional review specialist, at (517) 346-9411; Jo Ann Murphy, senior professional review assistant, at (517) 346-9430; Christine Wilson, professional review assistant, at (517) 372-9409; or Grace Deshaw-Wilner, CAE, assistant executive director/human resources and professional review, at (517) 346-9413.
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