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Stephen Oppenheimer, DDS has been in
private practice since 1981 and is a Dental Benefits Consultant for
Direct Reimbursement Benefit Plans (DRBP), P.O. Box 2130, Alpharetta,
GA 30023. DRBP is the largest administrator of direct reimbursement
plans for dental and vision in the country. For more information contact
Dr. Oppenheimer at 404-805-5521, fax 404-851-9733, or visit their Web
site at www.DRBP.com.
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Direct Reimbursement
(DR) benefit plans for dental care are good news for American business,
dentist-patient relationships, and the future of dentistry. DR is cost
effective, saving companies significant benefit dollars. It utilizes
a simple plan design that is easy for the employee/patient and dental
office to understand. DR payments to patients are based on actual dollars
spent rather than the type of procedure/care received. Claims processing
is efficient, with settlement in 7-10 days. Human Resource personnel
save valuable time and avoid aggravation from inefficient claims processing,
and delayed or disputed claims.
DR does not involve an insurance company or its built-in overhead and
risk charges. DR reimburses employees from an account funded by employee
and employer contributions. The benefit plan can be administered by
the employer or a “third party administrator” (TPA). Plan
design is flexible and can be tailored to the employer’s budget
and desired level of benefit.
The American Dental Association and its state and local components have
made significant inroads toward making businesses and dentists aware
of direct reimbursement benefit plans. The ADA does not sell DR benefit
plans itself; direct reimbursement benefit plans are sold by independent
brokers. Thousands of DR plans are now in effect. Many of these plans
have come into existence because dentists like you relayed a qualified
lead to a benefits consultant or local dental association for follow-up.
Dentists must step outside their traditional clinical role, “think
outside the box,” and assume the role as a member of the broad
business community. If you do nothing and leave it up to others, you
leave it up to the insurance companies to promulgate their more “cost
effective” managed care alternatives: HMOs and PPOs. Of course,
these alternatives have a decreased percentage of premium dollars going
toward actual care (according to the ADA, 73% of premiums paid to HMOs
go to actual dental care, compared with DR’s 90 - 95%), increased
administrative interference, and limited choice for both the patient
and dentist. When you promote Direct Reimbursement, you promote “freedom
of choice” healthcare where patients are free to choose who provides
their care, the type care, and the level of care they will receive.
You are saying that patients’ healthcare decisions should lie with
the patient and dentist, and not upon distant third party administrators.
It often takes a while for a company to switch from their current plan
to DR. There are numerous reasons: change is difficult, DR is a different
paradigm, DR is not an insurance product presented by most brokers,
companies decide at most once a year on benefit programs, and corporate
decision-making processes are complicated. Thus, it is important for
you to express your belief consistently that DR is the best dental benefit
program, both fiscally and administratively!
Fortunately, there are now brokers nationwide that sell and administrate
DR. The many companies using DR are the models and testament to its
success. Companies that have elected DR have stayed with DR! For every
prospective company, there is a Human Resource/Benefits Coordinator
of similar characteristics currently using DR who will speak of their
success and satisfaction with the program.
Companies that are prime candidates for DR have fifty or more employees.
They may currently have traditional indemnity insurance plans, no dental
benefit plan (but are interested in one), are self-insured through an
insurance company, or on a managed care plan but displeased with access
or perceived level of service or care.
Qualified lead opportunities arise throughout the day in every dental
office. Ideally, they occur in conversations with key decision-makers
(human resource personnel and upper level management) who happen to
be sitting in your dental chair. However, most employees know someone
in their human resource/benefits department to whom they can refer you.
These opportunities are present every time third party interference
enters your interaction with a patient, such as: uncertainty over what
insurance will pay, the perpetual mystery over “UCR,” pretreatment
estimates, delayed pretreatment estimates, delayed claims payments,
lost claims, etc.
A qualified lead should be relayed in a timely fashion and includes:
1) company name
2) initial patient contact name
3) human resource/benefits contact name
4) human resource/benefits contact telephone number
5) number of employees, and
6) information on the dentist initiating contact (name, relationship
and telephone number).
We must focus on the quality of patient relationships and care, and
be business savvy. The marketplace dictates that we cannot merely treat
dental problems, but we must understand, explain, and promote viable
alternatives for third party payment. The sooner more dentists understand
and accept this challenge and responsibility, the brighter the future
becomes for them and their patients.
Do not settle for the “path of least resistance,” or “alternative
minimal treatment,” but rather seek to develop values-based, responsible
partnerships. Look to produce long-term oral health for your patients
who want to feel good, chew comfortably, and look good for a lifetime.
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