Dentist CEO

Dental benefit plans: Devil’s in the details

April 11, 2018

When signing with a dental benefit plan, dentists typically focus a great deal of attention on the fee schedule, sometimes at the expense of other important clauses contained in their formal contract with the plan provider. As the California Dental Association outlines in a recent article, fees are just the tip of the iceberg, and there are many other important questions:

  1. Ask about the dental insurance plan network

Typically, smaller networks offer higher compensation, while larger networks offer lower compensation. It’s also important to recognize how many networks you’ll be “in network” with—just one network, or multiple networks?

  1. Review the specific plan’s handbook

Plan contracts may not always offer as much detail as the plan handbook. A plan handbook will have in-depth information on benefits, limitations, bundling, downgrading, and more detail on plan audits and recoupments. Once the contract is signed, all of those rules apply, so make sure you know what you’re signing up for.

  1. Understand how the new plan will affect your current patients

When contracting with a new dental benefit plan, some of your current patients might experience a change in benefits. They may, for example, no longer be covered for procedures they were accustomed to receiving at no out-of-pocket charge. The CDA recommends that you look carefully into how many of your existing patients will see their in-network benefits change as a result of the new benefit plan before you switch.  

Plan contracts may also contain additional stipulations about selling/purchasing a practice or adding additional locations that may not align with your long-term goals. As with any contract, the devil is in the details. It’s not just about the fees!