Ethics and insurance consultants

Health care professionals who serve as consultants for insurance companies provide an essential service in reducing health care costs and ensuring access to care for increased numbers of people. The role and function of these consultants is not always appreciated or welcomed by providers, who may view them as intruders to the doctor-patient relationship and feel that treatment plans are being second-guessed. Consultants, on the other hand, may be placed in uncomfortable positions when radiographically visible pathological conditions are not addressed on a treatment plan. Overlooking such conditions in hopes of not embarrassing the treating dentist is not an ethical option. When an isolated omission or error is encountered, it is best for consultants to contact the treating dentist and advise him or her of the disparity between planned treatment and observed pathology. Patients, providers, and the profession will benefit through this collegial exchange of information. When consultants observe continual omissions or errors, the stakes are much greater and the public's health must be protected through implementation of the peer-review system.