Dental practitioners must demonstrate adequate understanding of the existing Dental Plans and types of Dental Benefits if they are to succeed in providing optimal care to patients and receive sufficient reimbursement for the services provided. Direct reimbursement and indemnity insurance are two types of benefit models offered in the American healthcare landscape, each with its own benefits and limitations (Dental benefits, n.d.; Polverini, 2015). The present paper compares and contrasts the two insurance plans using dental/oral health as the context of discussion, before making a determination of which insurance plan is better for the dentist and the employer.
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In comparison, available literature demonstrates that direct reimbursement operates as a self-funded plan that permits patients to go to their dentist of choice and is based on the money used in the provision of oral health procedures, rather than the type of treatment provided by the dental practitioner (Dental benefits, n.d.; Rowell & Green, 2012). The indemnity insurance, on its part, revolves around the insurance entity paying claims based on the dental procedures performed on the patient, rather than the money spent on treatment. Additionally, most typologies of direct reimbursement allow the patient to use direct means to pay for oral health services or for the benefit to be directly assigned to the dental practitioner, before submitting a paid receipt or evidence of payment with the view to facilitating the administrator or insurance company to reimburse the patient a proportion of the dental care costs (Polverini, 2015).
In indemnity insurance, however, reimbursement for dental health services provided is made according to the patient’s plan of benefits which on most occasions is a proportion of the insurance entity’s fee schedule. Lastly, although both insurance plans provide some form of mechanism through which patients can choose their own dental practitioners, the indemnity plan is more restrictive than direct reimbursement as it has a maximum allowance for each dental procedure known as the “usual, customary and reasonable” (UCR) fees (Dental benefits, n.d.).
Direct reimbursement, in my view, is the most preferable insurance plan for dental practitioners due to its many advantages relative to the indemnity plan. For example, direct reimbursement provides freedom of choice for patients seeking dental health services, does not offer restrictions on fees for dental services, allows for treatment decisions to be made between the dental practitioner and the patient, and conserves dentist-patient relationships to allow for optimal treatment outcomes (Rowell & Green, 2012).
These benefits are non-existent under the indemnity insurance plan. Additionally, direct reimbursement is a better plan for the dental practitioner as it covers for all types of services (except for cosmetic treatments) and there are no waiting periods involved. Direct reimbursement is also a better plan than indemnity insurance when it comes to employers as it provides them with the capacity to control costs through the utilization of co-payments and yearly maximums. Additionally, direct reimbursement is not only effortless to administer and easy to understand compared to indemnity insurance plan, but it also provides added benefits to employers in terms of ensuring that payments are made for those employees who actually visit the dental practitioner (Dental benefits, n.d.; Polverini, 2015).
This paper has compared and contrasted direct reimbursement insurance plan with the indemnity plan, before determining which insurance plan is better for the dentist and the employer. Overall, it can be concluded that the benefits offered by the direct reimbursement plan far outweigh those provided by the indemnity plan, hence the determination to select it as the most preferred plan for dentists and employers.
Dental benefits: An introduction. (n.d.). Web.
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Polverini, P.J. (2015). Personalized oral health care: From concept design to clinical design. New York, NY: Springer.
Rowell, J.A.C., & Green, M.A. (2012). Understanding health insurance: A guide to professional billing (2nd ed.). New York, NY: Delmar Thomson Learning.