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ADA has resources to guide plan purchasers on how to create healthy smiles for their employees

August 27, 2019

By David Burger

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Editor’s note: This is the 27th story in the Decoding Dental Benefits series featuring answers and solutions for dentists when it comes to the world of dental benefits and plans. The series is intended to help untangle many of the issues that can potentially befuddle dentists and their teams so that they can focus on patient care.

West Greenwich, R.I. — Research suggests that patients with a dental benefit plan are more likely to seek dental care. Most individuals are covered by a benefit plan through their employers who negotiate group discounts for their employees and sometimes pay part of the premium for the plan.

When employers offer a dental plan for their employees, they’re not only helping to create great smiles.

They’re also trying to generate healthy, confident and productive employees who can help make companies successful.

A concern, though, according to Dr. Paul Calitri, a Rhode Island-based general dentist and member of the Council on Dental Benefit Programs, is that, in his opinion, employers tend to spend most of their time researching and evaluating the medical portion of health care coverage — and comparatively very little time on dental benefits.

And that should concern other dentists, as well.

“Dental coverage, along with vision, is often an afterthought,” said Dr. Calitri.

Many employers rely on brokers or consulting firms for recommendations on coverages, processing policies and other considerations.

The ADA policy on Standards for Dental Benefit Plans discusses the Association’s point of view on optimal structure for these plans. Further, the ADA Council on Dental Benefit Programs has developed a set of tools to help employers choose the best plans for their organizations, Dr. Calitri said. Dentists who treat human resources professionals, owners of businesses and other influential employees should talk to these individuals about concerns with their current plans and to discuss what constitutes a good dental plan. If encountering problems with plans not covering their particular treatment, a consumer can be directed to the ADA’s consumer website MouthHealthy.org, which houses a survey consumers can take that generates a score in which consumers can use to evaluate their plan: Mouthhealthy.org/en/dental-care-concerns/paying-for-dental-care/understand-your-plan.

The toolkit  contains information to help employers evaluate their employee dental plans and is located at ADA.org/en/public-programs/dental-benefits-plan-for-employees.

The toolkit offers questions that a purchaser should ask when shopping for the best plan for their employees, as well as questions to ask oneself when determining that the plan chosen fits their needs.

“We often hear dental benefit companies tell us at the Council that they only implement the employer choices and that the employer has the final decision.” Said Dr. Calitri.

Dr. Calitri said, “When many patients get upset with insurance companies when the latter won’t cover certain treatment, they should also look at their employers, who are the ones that decide on the coverage for their employees.”

Dr. Calitri stressed the next point.

“Plans that restrict patients’ choice of dentists should not be the only plans offered to subscribers,” he said. “In all instances where this type of plan is offered, patients should have the annual option to choose a plan that affords unrestricted choice of dentist, with comparable benefits and equal employer-contributed premium dollars. Employers should try to understand the overall satisfaction of dentists in the plan’s network to ensure that employees receive care within a network that values the doctor-patient relationship.”
 
Dr. Calitri concluded by saying that “dental benefit plan administrators should help employers communicate with employees regarding the importance of at-home routine oral care and regular dental visits to monitor and prevent dental disease.”

To speak with someone about selecting a dental benefit plan, employers can call the ADA’s Center for Dental Benefits, Coding and Quality at 1-312-440-2500.

The ADA’s online landing page for dental benefits information that can help dentists address and resolve even their most vexing questions is at ADA.org/dentalbenefits, part of the ADA Center for Professional Success.

Staff from the Center for Dental Benefits, Coding and Quality can help dentists with dental benefits-related and coding problems, questions and concerns. Call the ADA’s Third Party Payer Concierge at 1-800-621-8099 or email dentalbenefits@ada.org, or for questions on the code email dentalcode@ada.org.

Previous installments in the Decoding Dental Benefits series are available at ADA.org/decoding.