Looking for feedback on direct reimbursement dental plans from end-use

[Guest ronc]

We are looking for feedback from employers who have used direct reimbursement dental plans (good experiences and bad). Everything we get is from ADA or someone selling the product or selling the administration. We are considering such a plan for our employee through our dental school and are looking for information on employee acceptance.

[Guest cisbill]

I administer D R plans and other types of dental plans. The reason you hear such good things from dental associations and other "dental" groups about direct reimbursement usually has to do with dentists and how much money they take home! Most direct reimbursement plans do not pay claims based on a reasonable and customary fee schedual. They process charges as billed by the dentist. The employee goes to the dentist. Pays the bill and gets reimbursed from the Plan. However with no checks and balances on dental charges the plan and the insured are the ones to suffer. The patient "insured" usually never knows if he is being overcharged for services. In one area we administer claims for a prophy (cleaning) 1110 can go as low as $25.00 and as high as $78.00. In this area the reasonable and customary fee is calculated at $52.00. Remember that when you usually go to the dentist for a preventative visit you have a office visit charge, a cleaning charge and an xray charge. If that dentist is overcharging on one service then chances are that his fees are too high on most services. This means the insured will use up thier benefits at a faster pace and the plan will have higher costs than necessary.

This is a topic I could speak to at length and wont bore you with any longer. cya