Jaycee Brown

Jaycee Brown

Director of Communications

Direct Reimbursement Dental Insurance Plans

Dental insurance plans contain many terms and conditions. For instance, people must go to in-network dentists for HMO plans in order to receive coverage (Doheny, 2). In PPOs, people receive less coverage at out-of-network dentists than at in-network dentists. Dental insurance plans have many other caveats, such as monthly premiums, waiting periods, etc. Instead of using policies, such as HMOs and PPOs, people can utilize direct reimbursement dental insurance plans, which provide benefits differently.
Direct reimbursement plans can benefit people in many ways. These plans require funding from the employees or their employer who would “set aside a certain amount of money each year depending on a predetermined limit of coverage…” (Davenport 2018; Stone 2013). Businesses can benefit from these plans because businesses “only pay for the benefits they receive instead of paying large sums of money into a plan that is never used” (Workful 2018). Also, direct reimbursement plans’ benefits are “not limited to specific treatments,” so these plans usually include benefits for cleanings, prosthodontics, periodontics, and even “cosmetic services, such as teeth whitening” (Davenport 2018; “Direct Reimbursement Dental Plans Offer Many Benefits” 2001). Employees can also visit any dentist because these plans do not have networks, unlike HMOs and PPOs (“Type of Dental Plans”). Other benefits of direct reimbursement plans include no premiums, no deductibles, no preauthorizations, no waiting periods, and no missing tooth exclusions, all of which restrict coverage in other types of insurance plans (Davenport 2018).
In order to utilize the benefits of a direct reimbursement plan, beneficiaries have to follow its payment method. First, they usually pay their dental provider for their services and procedures at their provider’s “regular fee” (Stone 2013; “Types of Dental Plans”). Patients should get “a paid receipt or proof of treatment,” both of which are sent to a third-party administrator, an insurance provider, or their employer (Bowker 2017; “Direct Reimbursement Dental Plans Offer Many Benefits” 2001; “Types of Dental Plans”). Then, the patients would be reimbursed based on “a percentage of the dental care costs” (“Types of Dental Plans”). The amount of the patients’ reimbursement is affected by the plans’ “maximum yearly allowance,” which usually ranges between $1,000 to $1,500 (Davenport 2018). According to Tammy Davenport, “a dental assistant with experience on the clinical and administrative side,” “A common direct reimbursement plan would pay for 100% of the first $100 spent on dental services; 80% of the next $500; and 50% of the next $1,000” (2018). Since patients themselves pay for treatment, “Many DR [Direct Reimbursement] plans offer payment options for individuals who have difficulty paying ‘up-front.’ For example, reimbursement is often received prior to credit card payments being due” (“Direct Reimbursement Dental Plans Offer Many Benefits” 2001). Alternatively, some employers can pay for the employee’s dental treatments, so the employees would pay less out-of-pocket (Davenport 2018).
Although direct reimbursement plans provide coverage in ways different from other dental insurance plans, people can benefit from direct reimbursement plans’ other conditions, such as no premiums or waiting periods.
Works Cited

Bowker, Drew. “What does dental insurance reimbursement mean for the employee?” zenefits,
January 9, 2017. https://www.zenefits.com/blog/what-does-dental-insurance-reimbursement-mean-for-the-employee/.
Davenport, Tammy. “How a Direct Reimbursement Dental Plan Works.” verywellhealth. Last
modified May 22, 2018. https://www.verywellhealth.com/direct-reimbursement-dental-plan-1059058.
“Direct Reimbursement Dental Plans Offer Many Benefits.” DentistryiQ, November 15, 2001.
Doheny, Kathleen. “Dental Insurance: A Not-So-Rare Fringe Benefit.” WebMD. Accessed
March 21, 2019.
Page 1: https://www.webmd.com/oral-health/features/dental-insurance#1.
Page 2: https://www.webmd.com/oral-health/features/dental-insurance#2.  
Stone, Laurence H. “Dental Insurance vs. Direct Reimbursement. Why you need to understand
the difference.” Laurence H. Stone, D.D.S. Cosmetic & General Dentistry, October 8, 2013. https://www.drlarrystone.com/blog/dental-insurance-vs-direct-reimbursement-why-you-need-to-understand-the-difference/.
“Types of Dental Plans.” ADA Center for Professional Success. Accessed March 21, 2019.
Workful. “Direct Reimbursement Dental Plans.” workful Blog, December 24, 2018.


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