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BEFORE YOU CHOOSE A DENTIST FROM the ‘LIST' OF YOUR CARRIERS PROVIDERS ... YOU DESERVE THE FOLLOWING INFORMATION. 1) ASK YOURSELF... INFORM YOURSELF 2) DENTAL STANDARDS 3) TYPES OF DENTAL PLANS - Associates / Network of Specialists
1) ASK YOURSELF... INFORM YOURSELF
FACT - Dental practice overhead generally averages 65% of gross production. If a practice is ‘saving patients up to 25%-60% on fees, well... you do the math. FACT - Dental practices with over 20% of patients on ‘special discount rate plans COMPROMISE somehow, some way to create profit.
(Excerpt from American Dental Association, ADA, website) 2) Dental Standards Dental standards ensure that everyone is on the same page-those who design and manufacture dental products and the dentists who use them. Through comprehensive analysis, the ADA establishes baseline standards and technical recommendations for almost every tool of modern dentistry, from radiographic systems to sealants to manual toothbrushes. The ADA'S mission is to ensure the highest level of patient safety and professional satisfaction through the publication of clear industry standards for both dental products and dental informatics. The ADA is the accredited dental standards body of the American National Standards Institute (ANSI) and also designated the official United States representative for the International Organization for Standardization (ISO) Technical Committee 106 Dentistry (TC 106).
The ADA is an ANSI accredited standard developing organization. ADA standards have been approved as American National Standards by ANSI and thus they are designated as ANSI/ADA Standards. Further, ANSI is the U.S. member to ISO. The U.S. TAG for ISO/TC 106 determines the U.S. vote on all dental standards and provides this input to ANSI for ISO/TC 106. 3) Types of Dental Plans With so many dental benefit plans available to patients today, it's important to learn the differences between them. Some plans require your dental practice to be part of a network, others limit maximum charges and many have set fees for specific services. PROVIDERS? - Research background and affiliation with dental practice! Will the PROVIDER be available should you require follow up care? When, how often, are they scheduled in the office? Are they only in on an 'appointment/needs basis?' (Short term associates, or part time/contract specialists often work 'by appointment' in several offices and will not be available to 'stand behind their treatment.' (Ask yourself ... if you have pain requiring a root canal, do you want to be on pain medication 'waiting' for specialists to come to the office, or would you like to go to a local specialist right away?) You can generally rely on a provider standing behind treatment minimally up to five years' ... this is reflected in a carriers five year requirement to 'replace' a procedure.) Created by the ADA's Council on Dental Benefit Programs, it includes information about the management of dental plans, communicating with third-party payers, handling coordination of benefits. 1. Preferred Provider Organizations (PPO) A PPO plan is regular indemnity insurance combined with a network of dentists under contract to the insurance company to deliver specified services for set fees and according to the provisions of the contract. Contracted dentists must usually accept the maximum allowable fee as dictated by the plan, but non-contracted dentists may have fees either higher or lower than the plan allowance. 2. Dental Health Maintenance Organizations (DHMO)/Capitation Plans Under a DHMO or capitation plan, contracted dentists are "pre-paid" a certain amount each month for each patient that has been designated or assigned to that dentist. Dentists must then provide certain contracted services at no-cost or reduced cost to those patients. The plan usually does not reimburse the dentist or patient for individual services and therefore patients must generally receive treatment at a contracted office in order to receive a benefit. 3. Indemnity Plans An indemnity dental plan is sometimes called "traditional" insurance. In this type of plan, an insurance company pays claims based on the procedures performed, usually as a percentage of the charges. Generally, an indemnity plan allows patients to choose their own dentists, but it may also be paired with a PPO. Most plans have a maximum allowance for each procedure referred to as "UCR" or "usual, customary and reasonable" fees. 4. Direct Reimbursement (DR®) Benefits
in this type of plan are based on dollars spent, rather than on the type of treatment. Direct 5. Point of Service Plans Point of service options are arrangements in which patients with a managed care dental plan have the option of seeking treatment from an "out-of-network" provider. The reimbursement to the patient is usually based on a low table of allowances; with significantly reduced benefits than if the patient had selected an "in network" provider. 6. Discount or Referral Plans Discount or referral plans are technically not insurance plans. The company selling the plan contracts with a network of dentists. Contracted dentists agree to discount their dental fees. Patients pay all the costs of treatment at the contracted rate determined by the plan and there are no dental claim forms to file. Originally these plans were sold to individuals; however, more and more employers are purchasing these types of plans as the dental plan for the company's employees. 7. Exclusive Provider Organizations (EPO) Exclusive provider organization plans require that subscribers use only participating dentists if they want to be reimbursed by the plan. These closed panel groups limit the subscriber's choice of dentists and also can severely limit access to care. 8. Table or Schedule of Allowances Plans These types of plans are indemnity plans that pay a set dollar
amount for each procedure, irrespective of the actual charges. The patient is responsible for the difference between
the carrier's payment and the charged fee. The plan may also be paired with a PPO that limits contracted dentists to
a maximum allowable charge.Enter content here
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