The Explorer Winter 2018 Explorer_Fall_2018 | Page 12

DENTAL BENEFIT PLANS
From the ADA Center for Professional Success
Copyright ©American Dental Association. All rights reserved.
Many of your patients may have some
form of dental benefit coverage. In fact,
in 2013, 191.4 million Americans, or
61% of the U.S. population, were
covered by a dental benefit plan
according to the National Association of
Dental Plans (NADP) 2014 State of the
Dental Benefits Market.
DENTAL BENEFIT PLANS VARY
CONSIDERABLY IN TERMS OF WHAT
THEY COVER, TREATMENT
LIMITATIONS, REIMBURSEMENT
RATES AND FEE SCHEDULES.
In many practices, a significant
percentage of patients direct the
financial coordinator to “bill the dental
plan” and then pay the balance due
directly to the practice. Some patients
may automatically assume their dentist
is a participating provider in their dental
benefit plan.
While reading – and understanding –
the specifics of any contract is critical
in any situation, this advice is
particularly important when you’re
evaluating whether or not to become
a participating dentist for a third-
party plan.
Before you consider signing on as a
participating dentist in any new dental
benefit plan, make sure you review the
demographics of your current patient
base, the demographics of the potential
new patient base, and your available
capacity to treat new patients. Also
carefully consider the possible financial
implications of the fee schedule offered
by the new plan. The ADA offers
members a free Contract Analysis
Service (CAS) to help you understand
the contract. Take advantage of this
important member benefit by providing
your state dental association with a copy
of your unsigned contract and a request
for analysis. Please keep in mind that
this service is not intended to serve as
legal advice, but rather a tool to aid
members in understanding and
analyzing proposed contracts. Contact
your state dental association for
information on how to access this
member benefit. Pay close attention to language in the
contract that discusses developing and
supervising patients’ treatment plans;
you, as the dentist, should have full
authority and control.
Some plans have time-consuming
credentialing requirements that must be
fulfilled in order to join them. Make
certain you allow sufficient time for the
credentialing process to take effect if
you choose to join the plan. Be sure to
carefully review the requirements for
terminating the agreement, since
leaving a plan may require you to follow
some very specific and complicated exit
protocols. • Dental Benefit Video Series 䡲
Additional Resources:
• ADA Contract Analysis Service
• CDT 2018: Dental Procedure Codes
[ADA Catalog]
• CDT 2018 Companion: Help Guide
for the Dental Team [ADA Catalog]
• CDT 2018 Code Check App for iOS
and Android [ADA Catalog]
• Code on Dental Procedures and
Nomenclature
• An Introduction to Dental Benefits
• Third Party Issue Tracker
Los Angeles Dental Society Explorer