Dental Benefit Plans | American Dental Association

Dental Benefit Plans

Guidelines for Practice Success | Managing Finances | Revenue

Many of your patients may have some form of dental benefit coverage. In fact, in 2016, 248 million Americans, or 77% of the U.S. population, were covered by a dental benefit plan according to the National Association of Dental Plans (NADP) Dental Benefits Report: Enrollment, August 2017.

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.

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.

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.

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