dental membership plans vs. dental insurance

Most dental offices have a certain percentage of their patients that have no dental plan in place to help offset the expense of maintaining their oral health. According to the ADA, one of the biggest reasons that most people don’t go to the dentist is because of cost. One study indicated that 59% of Americans surveyed said they cannot afford to have dental work done. Dental fees as reported by the Consumer Price Index have risen by 20% over the past ten years, taking a toll on oral health and preventative care.

Almost two-thirds of the population, including those with dental insurance, fear they are unable to pay for dental care. As a result, too often patients wait a long time before getting simple preventive work completed that can prevent more expensive procedures at a later date due to neglect. The American Academy of Periodontology reports to the Centers for Disease Control that half of adults over age 30 have periodontitis, an advanced form of gum disease, which leads to severe dental issues if left untreated.

If that’s not enough, the dental industry, in general, has had a tough year economically as DSO’s and individual dental practices have had to close down for a season due to the impact of COVID-19, effectively shutting down approximately 198,000 active dentists and dental specialists in the USA according to the Agency for Healthcare Research and Quality (AHRQ). With most offices now reopened in the past couple of months, dentists are dealing with the rise in cost to their own business due to the additional operational expenses in treating patients and sanitizing their practices. Getting back into the fiscal black is still a challenge. 

Due to the variety of dental plans available to consumers in today’s oral health environment, it’s important to learn the differences between them. Some plans require your dental practice to be part of a network while others limit maximum charges. Also, many have set fees for specific services. Dentists need to have a fundamental knowledge of how dental plans work, regardless of the type and scope of the plan designs. 

Patients have become savvier over the past several years, and with the growth of online access for purchase and a variety of plan designs even by the same plan vendor, the awareness of what plans include what benefits and how they work can be an education in itself. 

Dental practices, including those with multiple locations and providers, must find ways to bring in new patients, keep their existing patient load, and increase revenues that provide additional profit. The traditional dental insurance plans that have been in the market for years include benefit coverages that can be easily exhausted if patients need extensive dental work. 

Even though most dental insurance plans include 100% coverage for preventive dentistry for patients, most restorative work is typically only covered at half of that. That usually means the patient must make up the difference out of pocket, something that many of them are unable to pay. The other option is for the dentist to set up some type of deferred payment plan through a third-party billing service which further eats into the profitability to the office. 

For the dental office, there is added waiting time for reimbursement of claims sent to the insurance carrier, and often those delays can take thirty to sixty days or longer if there are issues anywhere in the claims payment process. Delays of income to the dental office can be problematic if the accounts receivables are lagging too long. As well, especially for DSOs, this means additional personnel required to keep billings in check that add to additional cost for the business. 

Over the past several years, with the advent of dental membership plans growing in popularity by consumers, dental practices are beginning to see the light when it comes to accepting them. Many DSOs in particular are gravitating to developing their own plans with the help of licensed plan administrators who help manage the programs for their members. For a nominal cost, patients can save money using their membership plan without too many restrictions. Since there are no maximum limits on utilization, patients are able to use their dental membership plan as often as they need. 

There are multiple reasons why dentists should have their own dental membership plan, but one of the primary reasons is cash flow. Dentists collect immediate payment at the time of service, and there is no claims process delaying payment to the office. Additionally, the dental office collects a significant portion of the membership fee after a small administrative fee is paid to the plan administrator, thereby making up some of the discounted fees charged for procedures. Not only that, but these patients become more loyal to your practice over time. They have a vested interest in returning and referring others to you.

What type of dental plans should your office accept? The easy answer would be all of them. Yet, the best strategy would be similar to going to a cafeteria for lunch. You don’t have to take everything offered on the buffet line, but take those items that are best suited for your practice including a well-rounded blend of the best choices – make up your own dental plan menu of what is available. That should include both some insurance plans along with your own dental membership plan with the assistance of a qualified plan administrator at your service.

 

MEDIA RESOURCES:

https://www.ada.org/en/science-research/health-policy-institute/dental-statistics/patients 

https://www.bls.gov/cpi/tables/detailed-reports/home.htm 

https://www.perio.org/newsroom/periodontal-disease-fact-sheet#:~:text=According%20to%20recent%20findings%20from,equals%20approximately%2064.7%20million%20Americans

https://psnet.ahrq.gov/primer/covid-19-and-dentistry-challenges-and-opportunities-providing-safe-care 

https://success.ada.org/en/dental-benefits/dental-plan-overview 

https://www.guardiandirect.com/resources/articles/dental-insurance-vs-dental-discount-plans-comparison-chart 

https://www.thebalance.com/saving-on-dental-care-2386095 

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