Direct Reimbursement Plans: A trend waiting to happen

by Craig Beauchamp

Direct Reimbursement Plans (DRP) may be the upcoming trend to provide for one’s dental care needs, while at the same time letting many dentists regain control of their profession and get the financial compensation they deserve for their work.

The North Carolina Dental Society’s website states, “…dental care costs are predictable and non-catastrophic.”

Catastrophes fall under medical insurance and can not be planned for. Therefore, requiring the use of insurance companies to level the playing field by spreading the need for large medical payments over a larger population that pays, simply, for a maybe.

The fact is dental insurance funnels money out of your community and country, while at the same time taking control of the art of dentistry away from the dentist. It forces many dentists to work for less than they’re worth, adding to extra work load and stress while decreasing profit margins. This doesn’t even address the suppressed level of preventative care the average patient and his family receives, or needs, from his dentist to keep healthy teeth and gums.

With DRP, the money that a company would spend on insurance is put into an account that is set aside, accumulating interest, to be used as the employee sees fit. What is not used stays in the account collecting interest for the administration costs of the DR plan instead of for the insurance company. The patient and dentist have control of when and how it’s used. Of course the specifics of each plan differ depending on the company, but when informed of the savings and the increased oral health care and morale of employees, it only makes sense for more companies to start their own direct reimbursement plans.

The problem arises in the marketing. Insurance companies place a huge amount of their overhead into marketing. DR plans do not have that overhead, resulting in a lack of information and promotion on the subject. Many dentists say they feel that DR plans can’t succeed because of this.

Some DR plans require the patient to pay out of his own pocket and get reimbursed when they show their receipt. Some companies have given their employees with DR plans a debit card that has a certain amount allotted to it that will immediately be paid like any other debit card.

For the dentist this is fee for service, for the patient it is managed oral health, and for the company providing it there are multiple benefits. These range from increased production from healthier and happier staff to the knowledge that they are keeping money in their community. Some of that money will then come back to the doctors through the services they provide and even direct savings on the fees they have to pay to provide a good dental care program to their employees.
According to Dr. Keith Lever of Utah, “There is … higher case acceptance with direct reimbursement.”

Proper dental care and upkeep can allow a person to plan, with the knowledge and expertise of his dentist, for a healthy oral state. Even some level of cosmetics can be handled, such as braces.

Since there are no exclusions in a direct reimbursement plan, dentists and their clients can effectively plan a treatment plan that is approved by the expert; the dentist.

When asked why DR plans haven’t taken off better some dentists pointed out that it is in direct competition with insurance companies which spend millions a year in advertising. DR plans save money partly because there isn’t that marketing overhead. Yet because of it, companies don’t hear much about it.

This means that you have to go out there and create them!

Go get large companies, or small ones, the literature and build relationships with those companies that are in your community. Find out how many people they employ and do a mock up plan for them!

Dr. Andrew Lazaris of Plano, Texas said, “DR plans are great, but we need more employers to take part.”

The North Carolina Dental Society, the Utah Dental Association, the Illinois State Dental Society, and the ADA all have information available. The ADA can be contacted at 800-232-1890 or by e-mail at

There is also a list of third party administrators (TPA) that handle DR plans available from the ADA and state dental societies who can provide information on how to market DR plans.

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