What is Direct Reimbursement for Dental Care?

This type of dental insurance plan is funded by the organization. For example, an employer or company that sponsors coverage will require its members to contribute a certain amount. These contributions will make up the sum which will be used for the dental treatment of its members. This kind of set-up is the most ideal model for employers or companies that want offer dental care to their employees.

Most Direct Reimbursement Plans allow individuals to visit and avail the services of their own dentist while still retaining coverage. This is one of the best qualities of this form of plan because, when it comes to dental care, people are more discriminating and are more inclined to go to their own dentist regardless if there is coverage or none.

What generally happens is the insured member initially pays for the services rendered by the dental clinic of their choice. After which, an official receipt indicating the procedure done, related costs and date of payment will be handed to the insured party. He or she must then submit this receipt, which will serve as proof of treatment, to company-assigned administrator who processes dental reimbursements. A fixed rate is applied to the total cost and this will be the one to be compensated by the company. Rates differ according to design plans and requirements of each organization. It’s best to inquire to be more informed on how much will be deducted from the cost of a dental procedure.

It is called direct reimbursement because the employee has to “directly” pay the dental clinic upon receiving treatment. As mentioned, the reimbursement follows after the submission and confirmation processes. Depending on the company you work for, it can take a couple of days to a week before the reimbursement gets approved.

Less traditional, but also possible, would be that an employer or corporation pays the dentist directly. This lessens the chances of members shelling out from their earnings. However, this type of direct reimbursement happens rarely. In order to be safe, always be ready for an upfront payment when you visit your dentist.

Normally, an insured member can enjoy a 100% on the first hundred dollars he or she uses on dental care. For the next $500, 80% percent will be shouldered by the company and, lastly, 50% will be taken from the next $1,000 spent. The main objective of a direct reimbursement plan is to fit the design to the budget of the organization or employer.

One disadvantage of direct reimbursement is that your personal insurance carrier might refuse to reimburse dental costs. In providing insurance for its employees, a company has to negotiate conditions with insurance companies that cover its staff. Be informed and contact the necessary persons in your firm and insurance provider.

Overall, this type of dental plan is perceived more beneficial by many. It’s less complicated and efficient. Insured members spend less money on the administrative process and get compensated faster. There aren’t any deductibles, or premiums to be paid by the employees.