Who should determine the medical necessity of dental sedation and general anesthesia? A clinical commentary supported by Illinois patient and practitioner surveys.
Many third-party payers try to deny benefits for dental sedation and general anesthesia. The term "not medically necessary" is often applied to these services by third-party payers. The label is poorly defined and varies from payer to payer. This paper uses original practitioner and patient opinion surveys to support the position that the definition of medical necessity is solely the joint responsibility of the patient and his/her physician. These surveys also support the argument that both patients and practitioners view dental sedation and general anesthesia as a medically necessary procedure if it allows a patient to complete a medically necessary surgical procedure that he/she might otherwise avoid.
Flick
W G
WG
University of Illinois College of Dentistry, Chicago, USA.
Clayhold
S
S
D000766:Anesthesia, Dental / Q000191:economics* / Q000379:methods; D000768:Anesthesia, General / Q000191:economics*; D001291:Attitude of Health Personnel; D016292:Procedural Sedation / Q000191:economics*; D003815:Dentists / Q000523:psychology; D006301:Health Services Needs and Demand; D006801:Humans; D007342:Insurance Benefits; D007347:Insurance, Dental; D020380:Needs Assessment; D010361:Patients / Q000523:psychology; D011795:Surveys and Questionnaires