In response to Dr. Jeffcoat’s dilemma regarding her periodontal patient in "A Double-Edged Sword: Insurance A to Z" (July JADA), I can only say that she did everything right, and the patient’s insurance company did all it could to not pay her fee. Along the way, the carrier also undermined the patient’s confidence in her care, skill and judgment by saying the treatment was not medically necessary—despite what the company "meant to say."
As she mentioned, it would be nice if we could explain to every patient how his or her insurance plan works. This is impossible. It is the job of the human resources department of every company to do this task. The company is providing the insurance; we are providing the care.
We in the trenches are fighting the war every day. Our leadership in organized dentistry should rise and lead the way, at a national level, to combat the abuse you encountered. The Aetna settlement was one small step in correcting years of past misdemeanors. The ADA has to make the next move to protect the membership from future ingresses to our profession.
