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PEER REVIEW PROGRAM

The San Fernando Valley Dental Society (SFVDS), as one of 32 component dental societies of the California Dental Association (CDA), in keeping with their obligation of service to the public, ​participates in a statewide peer review system.

The purpose of the peer review system is to resolve disputes that may arise in the delivery of dental services to the public; in particular, disputes regarding the quality and/or appropriateness of dental treatment, utilization (problems related to dental insurance benefits when treatment is questioned), and/or potentially irregular billing practices.

The Peer Review program helps both doctors and patients avoid the costly and time-consuming process usually associated with legal action.

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A peer review committee, comprised of SFVDS member-dentist volunteers, evaluates all available evidence pertaining to each dispute and follows specific procedures (listed below) to make a fair and impartial determination. The parties involved are then notified of a committee’s decision by a letter of resolution. If any party to a review can factually demonstrate that a procedural error may have occurred, or that the decision was not based on available facts, an appeal to the Council on Peer Review at the CDA may be requested. This appeal must be mailed within 30 days of the date the letter of resolution is sent. Any decision of an appeal panel is final and binding.

Peer Review Procedures

All disputes that are evaluated within the peer review system must include the following procedures:

  • The responsibility for conducting a review will be that of the SFVDS and the California Dental Association.
  • The patient must sign a Patient Agreement Form prior to review. (The dentist, by virtue of his/her membership in the SFVDS and the CDA, has already agreed to be bound by a peer review decision.)
  • An Authorization for use and Disclosure of Health Information must be signed by the patient so that a review committee may legally obtain a patient’s records.
  • Unless the treatment in question cannot be evaluated (i.e., treatment has been redone and/or altered), the patient will be examined by a panel of at least three dentists.
  • The patient will be given an opportunity to present any additional comments, usually at the time of the patient examination.
  • The dentist is allowed to meet with the review committee if he/she chooses.
  • All other involved parties (subsequent consulting/treating dentists, insuring entities) will be contacted for additional evidence if available.
  • The peer review committee will evaluate all evidence available (patient examination results, radiographs, information from subsequent consulting/treating dentists, etc.), and make a final determination. This will be communicated to all involved parties in the form of a letter of resolution.
  • Involved parties will be provided an Appeal Criteria, if applicable, at the time the letter of resolution is provided.

Although the peer review system can satisfactorily resolve the majority of complaints received, there are limitations which may make a complaint inappropriate for the system.

The following types of complaints are NOT within the scope of the peer review system:

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Cases which do not meet "time" criteria

Excessive passage of time alters clinical conditions. Therefore, a complaint will not be reviewed if it is received more than three years from the date treatment was completed, or more than one year from the date the complainant became aware of the problem, whichever occurs first.

Cases in litigation

The peer review system is designed to resolve patient/dentist disputes. Consequently, no inquiry will be accepted for peer review if either party has initiated litigation (including small claims court); have initiated or have gone through a formal arbitration process and/or both parties have signed an arbitration agreement concerning any aspect of the dental services which might otherwise be reviewable.

Cases petitioning for monetary awards

Requests for reimbursement for time lost from work, pain and suffering, mileage and medical expenses cannot be accepted in the peer review system as it is not a punitive system, but rather an evaluative one.

Cases about fees

A peer review committee may not comment on a dentist’s fees. To do so may be construed as price fixing.

Cases not related to treatment

Questions concerning matters other than dental treatment (e.g., a dentist’s attitude, communications problems, etc.) are outside the purview of the peer review system.

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Initiating a Peer Review Case

If you have a complaint about one of our member dentists, please begin the process of starting a Peer Review case by calling the central office of the San Fernando Valley Dental Society at 818.576.0116. During this call, the central office will verify that the dentist is a member of our society and will help you to initiate your Peer Review case. It is important that we check the membership status of the dentist you wish to file a complaint about as we cannot open a Peer Review case if the dentist is not a member of the San Fernando Valley Dental Society.

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Additional information may be obtained from the California Dental Association web site:

www.cda.org under the member ​resources tab on the homepage.

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