Dental Insurance & the Standard of Care
Insurance seems to be quite a hot topic these days. Whether it is medical, dental, or, especially in North Texas, roofing insurance, there is no doubt that trying to stay ahead of the ever-changing policies and regulations seems to require a scholar’s level of legwork. While different types of insurance operate differently based on their purpose, it is important to understand the true nature of its function — a third-party payer.
The reason this is significant is because — especially in healthcare — it is the job of insurance to reimburse for benefits, not diagnose the disease. The reason this can complicate issues is evident in the way that you, as a patient, make a decision about your health. Though many diseases and disorders have options in regards to how they are treated, the diagnosis and optimal treatment do not and should not change based on the benefits of insurance. The bottom line is insurance benefits and medical diagnosis are not the same thing.
From a provider’s position, the balance is standard of care versus insurance claim requirements. The standard of care in any medical practice is governed by overseeing medical entities. In many cases, these standards include preventative practices that thwart irreversible damage. Too often, insurance benefits do not match these standards, whether they require signs of damage already visible, or if the frequency they allow treatment or diagnosis tools like radiographs to be performed. A patient and health provider should never compromise the standard of care to match claim requirements.
Finally, what many patients may not understand are cases of insurance fraud. Not only should providers not receive benefits for unnecessary procedures, but in general, providers must treat all patients and responsible parties the same. It is outside the terms of insurance to not collect certain portions from some patients and not others.
While most offices work diligently to ensure taking the most advantage of insurance benefits, the priority is always your overall health. As always, be sure to have these conversations with you provider to better understand your care.
