Direct Reimbursement Fact Sheet
What is Direct Reimbursement?
Here's how the Direct Reimbursement self-funding strategy
works.
Employees covered by Direct Reimbursement:
1. Visit the dentist of their choice
2. Pay for treatment
3. Present a paid receipt to their employer who then reimburses them for
covered expenses.
Does Direct Reimbursement reduce costs?
Yes! If an employer provides benefits through a fully insured dental plan, as much as one-third of the premium may be applied to administrative costs. With Direct Reimbursement, no insurance company makes a profit, no sales agent makes a commission. The elimination of such overhead expenses can result in savings of 25 to 35 percent.
What are other advantages of Direct Reimbursement?
Simplicity — Employees are reimbursed for a portion for their expenses, up to a maximum benefit allowance. Usually there are no deductibles and few, if any, excluded treatment procedures.
Right to Choose — Direct Reimbursement preserves an employee’s right to receive treatment from the dentist of his or her choice.
Flexibility — Employers tailor benefits to meet their budget allocations. Many employers who thought they could not afford dental plans are now offering attractive benefits through Direct Reimbursement.
How does Direct Reimbursement benefit dentists?
Direct Reimbursement eliminates insurance company intrusions. You and your patients make treatment decisions based on individual needs.
Direct Reimbursement eliminates:
Pre-authorization of treatment disputes
Least expensive alternative treatment limitations
Fee disputes resulting from out-dated UCR tables
What do employees think of Direct Reimbursement?
Employees appreciate being able to make their own decisions. Direct Reimbursement allows them the freedom to see the dentist they want and the ability to receive the treatment they feel is in their best interest. Since they are not insulated from costs, there is an incentive to ask questions and explore treatment options. This leads to healthy communication between patients and doctors.
How can you help?
Because Direct Reimbursement eliminates insurance company profits, few insurance brokers promote the concept. Employers probably will not hear about Direct Reimbursement unless you tell them. Here's how you can help.
1. Keep Direct Reimbursement promotional materials in your
office so you can share them with interested patients. If you need materials,
call the CDA at 800.232.7645, ext. 4961.
2. Involve your office staff. Discuss Direct Reimbursement in staff meetings on
a regular basis. Encourage staff members to recommend Direct Reimbursement to
patients who experience difficulty with insurance company payments.
3. Identify patients and friends who are decision-makers where they work.
Recommend they consider Direct Reimbursement the next time they review their
employee benefits package. (Tip: One dentist gem clips a Direct Reimbursement
brochure into the charts of business owners and managers. This is his reminder
to share information about Direct Reimbursement during the patient's next
office visit.)
For more information
Contact the California Dental Association at 800.232.7645 ext. 4961. We will answer your questions and fill your orders for Direct Reimbursement promotional materials.
When you find patients interested in Direct Reimbursement, let us know. We'll explain the concept, answer questions and assist them in designing a plan. CDA promotes Direct Reimbursement to help employers and employees get quality, cost-effective dental plans.