The fee-for-service model of dentistry was suited to a time when dentistry was just fillings, extractions, dentures, and crowns. Now, though, dentistry is a high-tech field geared to preservation and restoration rather than just to end-treatment. This approach is essential, but the costs have risen sharply as a result.
Even patients with dental coverage from their job will face significant co-pays and an arduous claim process that can often end in a denial, and with the population ageing more and more Americans no longer have employer-provided coverage at all even as dental insurance in the individual market can prove more costly than the care itself.
Meanwhile, insurers use their clout to limit reimbursement and constrict networks, and play out a game of delay/deny that swamps the dentist’s time, forcing many dentists to withdraw from accepting insurance coverage at all.
This situation called for an innovative approach and the dental profession is increasingly meeting that with subscription membership plans. In medical offices, this is often referred to as DPC, meaning “direct primary care”. This is a very good description because it addresses why these plans work well: the elimination of the for-profit insurer as a middle-man in the transaction between the patient and their provider.
Plan Design
In the dental setting, the practice will design a package of discounted (usually 10-30 %) preventive care (prophylaxis, evaluation, X-rays) and treatments. Unlike insurance, which pools and transfers risk between insureds, this arrangement is personal to the patient. Because it is essentially a discounted fee-for-service plan for the individual items in which each has its own price tag there are also no separate fees for the included services and there is no deductible.
These plans are often offered on a yearly basis but automated platforms and tracking software can allow monthly payments that fit better into patient budgeting habits and increase access by limiting up-front entry costs. Of course, every new policy rose will have its regulatory thorns…
Regulatory Issues
Since this a contractual transaction and occurs in an area – healthcare – that is subject to government and dental board regulations, the first step is making sure that your state allows this and what limitations it may place on it. Some of the requirements that a dentist should expect to see are that the agreement must clearly state that it is not dental insurance, that it must specifically state what the included services are, that it should clearly prohibit the practice from billing insurance for the included services, that it must allow the patient to terminate at any time, and that there should be a 30-day refund policy. In addition to the state and dental board restrictions, the practice must follow the professional advertising rules of the state and to Federal Trade Commission regulations.
Patient Communication
The practice should also bear in mind any state or local consumer protection laws, or the possibility that it might have to legally enforce the agreement. Staff members who will be explaining the agreement to patients should be trained on exactly what to say. The language of the agreement itself should be clear to a lay person and the pages should be spaced and use font to be easily readable. Even if the patient is enthusiastic they should be encouraged to take the agreement home to think about it rather than just signing up on the spot when they are in the office (and possibly even had anesthesia). If the practice ever has to prove that there was “a meeting of the minds” on the agreement it will want to be able to show that the patient had time to think about it and could actually read and understand it. If you have questions about setting up a subscription plan for your practice that will serve both your business and your patients’ dental care needs, contact us at info@byrdadatto.com to schedule a consultation.
