A PRIMER ON IN-OFFICE DENTAL PLANS

A PRIMER ON IN-OFFICE DENTAL PLANS

We regularly get telephone calls from member dentists inquiring about “in-office dental plans” that they have heard about. The most common questions are:

  • How do in-office dental plans work?
  • Are in-office dental plans legal?
  • Are there resources available to assist with plan design and administration?

Below is a brief answer to each question.

How do In-Office Dental Plans Work?

In-office membership plans provide an alternative to traditional dental insurance and third-party discount plans. They allow dentists to offer their uninsured patients the ability to join the plan and pay a monthly or yearly fee directly to the dental practice in exchange for services and discounts created by the dentist. For example, a dentist may have an in-office dental membership plan that requires the patient to pay a monthly fee (charged to a credit card) and in return the patient would be eligible for preventive wellness care, including basic dental exams, teeth cleaning and x-rays. For restorative and cosmetic dental procedures, the membership programs typically provide a discount to members.

These plans are flexible. The dentist can design the plan features as he or she believes is a best fit for the practice and patients. A recent ODA membership survey revealed that nearly 1 in 5 dental offices in Ohio are offering some form of an in-office membership plan. The dentists report that using an in-office membership plan has many benefits including:

  • Creating a predictable, recurring revenue stream that may be a better alternative to traditional insurance reimbursement revenue.
  • Helping to reduce the cost barrier for uninsured patients to get the care they need.
  • Increasing case acceptance.
  • Improving patient loyalty.

Are In-Office Dental Plans Legal?

Ohio law sets out some simple rules to follow for a compliant direct primary care agreement with patients, including the following:

  • The agreement must be in writing.
  • The agreement must be between a patient (or the patient’s legal representative) and a health care provider and must be related to services to be provided in exchange for the payment of a fee to be paid on a periodic basis.
  • The agreement must allow for either party to terminate the agreement as specified in the agreement.
  • The agreement must require termination to be accomplished through written notification.
  • The agreement must permit termination to take effect immediately upon the other party’s receipt of the notification or not more than 60 days after the other party’s receipt of the notification.
  • The agreement may not impose a termination penalty or require payment of a termination fee.
  • The agreement must describe the health care services to be provided under the agreement and the basis on which a periodic fee is to be paid in exchange for those services.
  • The agreement must specify the periodic fee required and any additional fees that may be charged.
  • The agreement must authorize that the periodic fee and any additional fees may be paid by a third party.
  • The agreement must prohibit the health services provider from charging or receiving any fee other than the fees prescribed in the agreement for those services prescribed in the agreement.
  • The agreement must conspicuously and prominently state that the agreement is not health insurance, is not subject to the insurance laws of this state, and does not meet any individual health insurance mandate that may be required under federal law.

Dentists should always consult their own attorneys and consultants in determining the best approach for their specific circumstances.

Are there resources available to assist with plan design and administration?

While dentists can set up and manage their own in-office membership plan, many dentists have found that setting the plan up and administering it can take a great deal of time and effort. Upon hearing these concerns, the ODA Services Corp. researched the marketplace to find a solution. ODA Services Corp. Chairman Dr. Tom Matanzo recently said that “the ODA Services Corp. Board listened to what our members were saying about in-office dental plans and our board spent time vetting platforms to find the best available.” The ODA Services Corp. has endorsed DentalHQ as its preferred platform. With the ODA Services Corp. In-Office Membership Plan, powered by DentalHQ, the dentist is able to have total control over setting the fees and defining covered services and discounts. The DentalHQ platform allows the dental office to automate the plan, lessening the staff time required for administration. According to Matanzo, “DentalHQ makes it simple, turnkey and user-friendly both in terms of setting up the plan and managing it.”

To learn more, sign up for a free web demo, and enroll in the ODA Services Corp. In-Office Membership Plan powered by DentalHQ visit https://www.dentalhq.com/ohio.