Dental insurance plans--boon or bane to the dental practitioner?

The dentist who participates in reimbursement pursuant to a dental insurance plan establishes a legal relationship to the insurance carrier, which is governed by third-party beneficiary concepts in law. The terms of the dental plan provide specific links to the provider of dental services, which include the right to review the quality of dental services rendered, the right to determine what are reasonable charges for the services rendered, and the right, through subrogation and indemnification, to recover what the insurance carrier determines to be improper payments to the insured and the dentist. The enforcement of those rights against the dentist can affect the manner in which he practices his profession. The failure of the dental practitioner to properly protect his interests when challenged by the insurance carrier under the plan can have adverse and far-reaching consequences upon his practice and upon his very license. It therefore behooves the dental practitioner to be fully knowledgeable of the potential pitfalls to his participation in dental insurance plan reimbursement programs. Unfortunately, the touting of the benefits accruing to the dental practitioner by participation in such plans tends to mask their dangers. It is hoped that this article will have shown that it is incumbent upon the dentist to ensure that his professional record with the insurance carrier and any dental review board accurately reflects proper professional judgement by him in participating in a dental insurance plan.