Abstract
Dental insurance claims sit at the intersection of professional ethics, contract administration, and regulatory oversight. This article argues that claim submission and payer adjudication should be treated as ethical practices grounded in truthfulness, fair use of shared resources, and respect for patient autonomy. Common failure modes range from misunderstandings of benefit provisions to intentional misrepresentations of diagnosis, procedure coding, dates of service, or supporting narratives. Because payer communications and attachments become part of the claim file, inaccuracies may create downstream harm, including patient financial confusion, audit exposure, recoupment, network consequences, and professional discipline. This article offers practical guidance to help dental teams reduce risk while strengthening ethical culture, including nonnegotiable “red lines,” documentation and pre-submission review standards, and a “stop-the-line” escalation pathway when the clinical record does not fully support a claim.
Recommended Citation
Rosenthal, Robert DDS
(2026)
"The Ethics of Dental Insurance Submission and Adjudication,"
Journal of the American College of Dentists: Vol. 93:
No.
1, Article 6.
Available at:
https://commons.ada.org/jacd/vol93/iss1/6
Included in
Bioethics and Medical Ethics Commons, Health and Medical Administration Commons, Leadership Commons, Other Dentistry Commons