Dental Insurance Plans: Direct Reimbursement Plan

Among the many kinds of dental insurance that help individuals and households manage their medical costs, one popular type of plan is called a direct reimbursement dental plan. This kind of policy is often valuable to customers, though sometimes not entirely understood. There is a basic way that direct reimbursement plans work on behalf of customers and providers. Knowing more about these kinds of plans will help policy holders make the right decisions about care and future benefits or insurance options.

How a Direct Reimbursement Dental Plan Works

There are a number of different kinds of direct reimbursement dental plans. What all of them having common is that the direct reimbursement dental plan follows a procedural standard: the policy holder goes to the dentist, pays the bill up front, and then submits a copy of the bill directly to the employer or other group insurance manager. The group insurance holder then pays the bill out of a “pot” or core account that includes a fixed amount of money for covering each policy holder and dependent.

Direct reimbursement dental plans differ from many traditional plans in that with classic dental insurance plans, dental offices often send the bill to the insurance company first. Some patients prefer to have plans where they don’t have to pay the dental bills up front, but the popularity of direct reimbursement plans has a lot to do with some specific problems dental customers have encountered after the dental office has submitted bills on their behalf.

Many traditional dental plans have problems with denials of dental bill claims, where the resulting dental fees just get “kicked around” between the patient and the insurance company. A major point of many direct reimbursement dental plans is that the health insurance company doesn’t need to evaluate payouts, so that denials won’t usually occur.

Who Benefits from Direct Reimbursement Dental Plans

Those who benefit most from direct reimbursement dental plans are households with enough money to temporarily cover all of their dental costs. Some younger families may benefit if they would otherwise be subjected to rejections or claim denials for “unnecessary services” like sealing teeth, orthodontics, or anything else that helps avoid higher dental costs later in life. At the same time, those who do not have any cash savings whatsoever will not benefit well from direct reimbursement types of medical or dental plans.

Direct Reimbursement Plan Offerings

Major insurance carriers like UnitedHealth and MetLife offer group dental insurance with direct reimbursement options. A wide range of other companies also offer these kinds of dental insurance policies. Dental insurance and medical insurance systems vary by state. A good resource for locating state specific dental insurance companies is a state insurance agency or organization, many of which maintain online resources. Those who want to find direct reimbursement plan options can contact these organizations or the companies directly to find out about local opportunities.

If your employer offers direct reimbursement, or your family has access to this kind of dental plan through other avenues, think about the above in selecting between dental policy options.

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