Dentists who serve as benefit consultants, reviewing claims and validating the appropriateness of treatment, play an important role in reducing fraud that takes funding away from patients in need of care. Without dental insurance and the dental benefit industry, billions of dollars that now pay a portion of care for 50 percent of the U.S. population would disappear. Individuals are unlikely to replace these funds out-of-pocket.

There is another option—cooperation among dentists, insurers and benefit consultants for the good of the profession, the patient and the practitioner. Many practicing dentists feel wronged by insurance companies, second-guessed by claims reviewers and accused by explanation of benefits statements as "proof" of overcharging. It is exactly for those reasons that some practicing (and licensed but currently nonpracticing) dentists have chosen to become dental benefit consultants.

These consultants believe that by putting their dental training and practical experience to use reviewing claims, they help other dentists and the dental profession. How? First, dentists who are dental benefit consultants are more likely to understand both the medical necessity and the ambiguity of real-life practice than nondentists. They have stood by the dental chair and practiced in the operating suite themselves.

Secondly, dentists who are dental benefit consultants also understand that the trust of patients is essential for ethical, successful treatment. Whenever fraud and abuse—or even systemic mistakes—are permitted to persist, it weakens the bond of trust between dentists and their patients. Reducing and eliminating fraud, abuse and unethical treatment benefits everyone—patients, dentists and insurers—and helps assure that funds will be available to reimburse legitimate expenses.

Thirdly, the future of dentistry as a profession is dependent on its continued adherence to sound science and best practices. Dentists who are dental benefit consultants support evidence-based dentistry, treatment protocols that follow accepted standards of best practice and ethical conduct in billing and record-keeping as the professional ideals to which we as dentists aspire, and against which we are measured.

By helping to encourage the practical application of sound science, dental benefit consultants advocate for quality dentistry with both dentists and insurers. Not only does dentistry itself win when such standards are upheld, but patients win because the dentist-consultant review reduces fraud, abuse and unethical record-keeping by a small minority of dentists whose conduct sullies the reputation of dentistry. Patients also win when evidence and best practices contribute to a reduction in health disparity by encouraging adherence to proven, measurable standards of care.

The organization that speaks for most dentist benefit consultants is the American Association of Dental Consultants Link opens in separate window. Pop-up Blocker may need to be disabled.. Many of our members are also members of the ADA and other dental organizations and many are in private practice, also serving as dental directors, clinical consultants, network managers, administrators and independent consultants for the insurance and dental benefit industry.

The AADC shares many of the ADA's concerns about issues that impact dentistry, including access to care; governmental health programs (Medicare and Medicaid); changing demographics in the general population and dental workforce; evidence-based care; the cost of health care benefits; the weakness of current dental delivery systems; the impact of new technologies; dental disease prevention; and the globalization of dentistry.

Last year the AADC invited Dr. James Bramson, ADA executive director, to speak at one of our meetings. He called for cooperative action by and between the ADA and the AADC in his keynote speech, and the AADC welcomes the opportunity to do just that. Our goal is to jointly meet the challenges of our rapidly changing profession and the evolving technologies that affect it. We invite any interested dentist to find out more about us.

Source: ADA NEWS, Vol. 38 No. 5 March 5, 2007

Dr. Robert Laurenzano, a certified dental consultant, is AADC president-elect and is in general practice in North Potomac, Md.