FAQ (Frequently Asked Questions)
Answers to our most commonly asked questions are provided below.
Q: Will a list of participating dentists be available to patients?
A: There are no "lists". Patients have the freedom to choose ANY dentist they wish.
Q: Is there a provider contract to be signed by the dentist?
A: None at all. The dentist simply chooses whether to accept payment from the plan administer, and the office co-pay, where applicable, if it is a DA plan.
Q: What if a dentist accepts payment from the plan administrator for a period of time and then decides not to do so any longer?
A: This is entirely up to the dentist. Again, there is no contract to be signed so the dentist has the ability to govern the practice as he/she sees fit.
Q: Who designs the plan?
A: The employer designs the plan that fits his/her company's particular needs in close consultation with a broker or third party administrator who is familiar with Direct Reimbursement and Direct Assignment concepts.
Q: Is there more than one benefit schedule available?
A: Benefits will be determined by the employer or plan sponsor. Plan designs may utilize various features such as tiered benefits, co-payments, or deductibles.
Q: How are monthly contributions calculated and who does this?
A: Licensed Third Party Administrators provide cost-estimations for each prospective purchaser of a DA/DR plan that are formulated using past claims history, group demographic data and software programs developed by actuaries who are expert in designing self-funded, dollar-based dental plans.
Q: Who are contributions paid to?
A: Under a typical DA/DR plan, contributions will be deposited into an escrow account for the particular employer's plan. The plan administrator will, among other services, pay claims from the fund.
Q: Will DA/DR work for small groups?
A: Yes, because of the diversity of plan administrators and plan designs, self-funded plans can be established for groups as small as 20 employees.
Q: Are dentists required to wait until after the claim is paid to collect the patient's portion of the bill?
A: Dentists have complete autonomy over their practices. However, the attraction of plans based on the DA concept will be the payment to the dentist from the plan administrator aspect, enabling patients to have more expensive treatment without incurring all the up-front costs.
Q: Will TMJ or cosmetic treatment be covered?
A: Under the DA/DR concepts, plans are dollar based, not procedure based. All dental services are covered; unless otherwise excluded by the employer when the plan is designed. Cosmetic "bleaching" dentistry IS NOT covered.