Dental Professionals
As you know, the ADA supports fee-for-service, freedom of choice dental plans.
One such option is Direct Reimbursement (DR), a concept that more and more companies are discovering via the ADA's recent marketing efforts.
Some of your patients may already have DR—all you might know is that they are paying with cash, check or a credit card. By learning more about DR, you can support those employers who use DR, as well as encourage other employers in your patient base to consider this innovative benefit option.
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DR is for groups
not individuals.
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What is Direct Reimbursement?
Direct Reimbursement plans may take many forms, but all DR plans share three essential elements: 1) they are self-funded by the employer; 2) they allow freedom to choose any dentist; and 3) they reimburse patients based on dollars spent on dental treatment, not based on type of treatment received.
- DR/DA Presentation | Flash file/2MB
Note: Turn computer sound on. Duration Five Minutes.
Thank you to the Florida Dental Association who provided the presentation for use on ADA.org, and is responsible for it's content.
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How Does DR Work?
With a DR plan in place, the covered individual visits the dentist, receives treatment and arranges for payment, and later presents a paid receipt or proof of payment to the employer for reimbursement. The employer then reimburses the employee directly, based on the company's plan design. The plan design will vary according to a company's budget.
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How Do I Process a DR Patient's Payment?
A patient with a DR plan needs a simple statement of services and receipt that show that treatment has been received and payment made. Typically, the standardized ADA claim form will suffice, and no subsequent action on your part should be required.
Some companies administer the plan themselves and others use a third-party administrator (TPA) to process and reimburse claims. In addition, some employers offer DR with an assignment of benefit, which shifts the requirement of payment from the employee and places it on the TPA or on the company. In this case, when you do not collect payment from the patient, you would fax or mail the claim according to the information listed on the employee's ID card.
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Dental Benefits Plans
The dental benefits market offers many plan options for employers. Employers must select among indemnity plans, direct reimbursement plans, dental HMOs, dental PPOs, and other plan types.
Learning about dental insurance is a necessary part of running a dental office. Administrative processes vary among plans, and different plans will reimburse you differently for the same services. In addition, patients sometimes rely on their dentists as a resource for their questions about dental benefits options.
The ADA has an introductory resource for employers called the Buyer's Guide to Dental Benefits, which is available online. This resource explains the differences among the major types of plans, provides questions to ask before selecting or changing a dental plan, addresses coordination of benefits, and even contains a glossary of terms.
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Why recommend Direct Reimbursement dental plans?
By learning about DR, you can support those employers who use DR, and encourage other employers in your patient base to consider this innovative, simple benefit option. Recommend DR, a great plan for your patients and your practice because it's a win-win-win for dentist, patients and employers. There are benefits to all three parties involved.
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Benefits of DR to Patients
- Simple to understand.
- Freedom to choose any dentist for treatment.
- Reimbursement is based on dollars spent, not type of treatment received.
- Reimbursement amount is known in advance
- No pre-authorization requirements.
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Benefits of DR to Employers
- Cost control through the use of co-payments and annual maximums.
- No premiums. Instead, payment is made for those employees who actually visit the dentist.
- It is cost effective since 88-90% of the dental benefit dollars are spent on actual dental care, not on the overhead, staffing, advertising or marketing of a third-party insurer.
- Fewer employee complaints about dental plan.
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Benefits of DR to the Dental Office
- Preserves dentist-patient relationships.
- Reduced paperwork and red tape in office.
- Allows dentists to determine treatment with the patients, without interference from a third-party payer.
- Encourages fee-for-service, freedom-of-choice dentistry.
- Typically, all dental services are covered (except cosmetic).
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Resources
The ADA and many state dental societies have developed free resources to assist your dental office in promoting DR to patients. Please call the ADA's Dental Benefits Information Service if you would like to obtain any of these resources, or if you have questions about Direct Reimbursement dental plans.
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