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Managed Care and Ethics in Dental Field


Professionals in the dental field play a significant role in restoring the wellbeing of the patients with issues of the oral cavity (Owsiany, 2008). These experts ought to offer the most excellent treatment options and preventive alternatives for the best interest of the patient’s welfare. Besides, the experts should observe certain ethical standards in their service delivery. This paper highlights the possibility of occurrence ethical dilemmas.

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Third Party Payors

Dental professionals might be faced with ethical dilemmas when dealing with third party payors. The ethics governing dental profession requires the personnel within the field to be compassionate enough to care and be able to identify the overall well-being of patients and relieve pain and suffering. To achieve the desired results, these professionals are also supposed to be competent by accurately assessing the oral health problems of the patients and offering them optimum care by utilizing their professional skills and knowledge as stipulated by the law (Owsiany, 2008).

Some patients rely on third party payors to offset their medical bills. Unfortunately, an insurance policy may not cover a treatment course entirely, and the patient may need to cater for the remaining expenses. For instance, a policy may not cover special procedures proposed in good faith by a dentist as listed in the relevant plan. If the insurance service provider sees a procedure unnecessary, it invokes the provisions of the contract between it and the patient thus preventing the dentist from billing him/her (Owsiany, 2008). Consequently, the dentist may fail to offer necessary services to the patient for optimal health, especially if the client is unable to cater for the treatment expenses.

When an insurance service provider ‘disallows’ a service, therefore, determining definitively that the patient does not need the service prescribed by the doctor, the third-party payor may interject the insurance plan. This may otherwise have covered the costs of the procedure into the relationship between the dental expert and the patient. As a result, the professional judgment of the dental professional is contravened (Owsiany, 2008). When such determination occurs before the dental professional performs a procedure, the third payor puts the dentist in an ethical dilemma of failing to carry out the procedure that deems necessary to him/ her or performing it without hoping to be compensated.

Ethical Dilemmas

One type of insurance is usually more prone to ethical dilemmas than another. Insurance policies with comprehensive coverage, particularly those offering preventive and well-care services like routine therapies and pediatric care at no extra cost, enhance the flexibility of a dental professional in offering his or her services. They enable the expert to give patients a wide range of preventive solutions and health improvement programs for optimum oral health with no fear of financial issues as compared to those with minimal or no coverage. For instance, health maintenance organizations (HMOs) plans provide the members with comprehensive medical care services hence giving a dental expert an easy time while prescribing a treatment course or performing a procedure since he/she is certain that the compensation is available. On the other hand, preferred provider organizations (PPOs) have more limited coverage as compared to HMOs, thus increasing the likelihood of putting a dental professional in a dilemma while planning to prescribe a certain course of treatment or preventive programs to some patients (Wagner & Kongstvedt, 2013).


Limited scope covered by various insurance types is the major hindrance to efficient service delivery by dental professionals. Although these experts strive to remain ethical, sometimes they may not provide their services as required since the insurance plans may not include certain treatment options under their umbrella.


Owsiany, J. (2008). Issues in dental ethics. Journal of the American College of Dentists, 75(4), 47-53.

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Wagner, E. R., & Kongstvedt, P. R. (2013). Essentials of managed health care. Burlington: Jones & Bartlett Learning.

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