Gerald Winslow's Survey of Issues in Dental Ethics Tempts Dark Thoughts About the Morality of Some Insurance Companies
David R. Larson
Bronwen F. Larson
Gerald Winslow, one of the Vice Presidents of Loma Linda University Medical Center, pinpointed “The Top Ten Ethical Issues in Dentistry” for a large audience on Wednesday, February 19. His presentation tempted some to think dark thoughts about the morality of insurance companies.
Winslow spoke to students, faculty and members of the community in a Center for Christian Bioethics Grand Rounds at the LLU School of Dentistry. Roy Branson is the Center’s Director and Alice Kong is its Coordinator.
Winslow’s presentation was drawn from a survey of dentists and dental educators in California and Indiana that he and Charles Goodacre, a recent Dean of the LLU School of Dentistry, conducted. Following a method television host David Letterman has made famous, he began with the issues that these professionals mentioned least and ended with those they spoke of most:
10. Unethical or illegal use of dental auxiliaries;
9. Patients making unwise dental decisions;
8. Dental students “practicing” on patients;
7. Failures to refer patients when appropriate;
6. Academic integrity in dental education;
5. Dealing with unprofessional or incompetent colleagues;
4. Pressures on dentists who work for corporations other than their own;
3. Misleading advertising;
2. Insurance companies that frustrate good patient care;
1. Dentists who over-diagnose and over-treat patients for financial gain.
Winslow reported that Issue # 1 was mentioned twice as often as any of the others.
Toward the end of his presentation Winslow stated that the American Medical Association and the American Dental Association differ in their positions regarding members of their societies waiving copayments for financially needy patients. A check after his presentation confirmed that he was correct.
On the one hand, Section 5B.1 of the American Dental Association’s Principles of Ethics and Code of Professional Conduct warns that “A dentist who accepts a third party payment under a copayment plan as payment in full without disclosing to the third party that the patient’s portion will not be collected, is engaged in overbilling.” It explains that “The essence of this ethical impropriety is deception and misrepresentation; an overbilling dentist makes it appear to the third party that the charge to the patient for services rendered is higher than it actually is.”
On the other hand, according to Opinion 6.12 in the American Medical Association’s Council on Ethical and Judicial Affairs, “When a copayment is a barrier to needed care because of financial hardship, physicians should forgive or waive the copayment.”
It is significant that the Opinion says that physicians should do this, not that they may. Yet the Opinion goes on to say that “Physicians should ensure that their policies are consistent with applicable law and with the requirements of their agreements with insurers.”
That in almost every case doctors and dentists ought to fulfill the requirements of the contracts into which they have freely entered is beyond dispute. The question is whether they should agree to such contracts in the first place.
There are so many other ways by which insurance companies can make sure that too many patients don’t take too much advantage of their services, thereby putting their entire operations at risk, that one wonders why it is necessary to prevent dentists from occasionally waiving copayments for those who are truly needy.
The idea insurance companies might force such policies upon dentists and their patients for the sole purpose of increasing their profits is a dark thought. Very dark.