Dental Care - maximizing your benefits

Preferred Dental Provider Network

Dental Cost

The paradox of rising dental costs:

the supply of dentist per capita has increased dramatically
the need for dental services has declined because of better preventive care
the dental claims per individual rises much faster than the general CPI

Using the economic laws of supply and demand, we would expect the cost of dental care to decrease since the supply of providers has increased and the need for service has decreases. The traditional cost control measures of plan limitations and cost shifting are not as effective as anticipated.

Preferred Dental Providers

A preferred provider network eliminates those providers that do not provide good value.

Service providers are paid fees for the services performed and not paid per patient like capitation programs.

A preferred provider network of dentists can:

eliminate excess services
eliminate unnecessary services
negotiate a lower fee schedule
reward dentists based on treatment outcomes

Infrastructure

The network manager is responsible for:

Quality Control:

Regularly evaluate facilities of providers
- equipment
- sterilization techniques
- emergency facilities
- administration
Oral or written patient surveys
- punctuality
- office environment
- staff attitudes
- communication of treatment plan
- pain management
- perception of treatment outcome
- communication of expenses

Cost Control:

negotiate lower fees
adjudicate predetermination of specialty services
analyze claims to identify unusual practice profiles
removing uncooperative practitioners