Every dentist involved with dental benefits and every dental plan administrator should read Dr. Gordon Christensen’s article, "Elective vs. Mandatory Dentistry" (October JADA). It clearly cuts to the heart of a key issue in dental benefits, the lack of understanding of the Alternate Benefit provision by both dentists and the dental plan administrators.
As Dr. Christensen correctly points out, a major portion of dental treatment is "elective." When properly administered, elective procedures may be selected without restrictions. This permits the patient to elect a more sophisticated service and the dentist to be paid his or her usual charge. The plan pays the allowance for the "least expensive" service and the dentist may charge the difference up to his or her usual fee.
Dental plans that do not permit patient and dentist to elect a higher level and more costly service do a serious disservice to both the patient and the dentist by denying patients freedom of choice—the opportunity to avail themselves of the finest dentistry available.
Alternate treatment is the friend of both dentist and patient. It permits the patient freedom of choice of treatment and enables the dentist to provide a finer service without suffering financial loss.
A more common illustration than in Dr. Christensen’s article is the replacement of bilaterally missing posterior teeth in one arch. Properly administered, the plan would allow possibly 50 percent of $700 for a removable partial denture. The plan would pay $350. The patient would also pay $350. If the doctor’s usual charge was $900, and he or she was a participating dentist in a dental plan, he or she had to discount the services by $200. If the patient and doctor elect a more expensive service, a fixed partial denture, the doctor’s fee may be $3,600. In this case the patient would pay the difference of $3,250.
Purchasers and plan administrators must more carefully craft and administer their products to ensure the alternate benefit provision is not only present in a dental plan, but also understood and properly administered.
If this is done, the effect is twofold. First, it minimizes the escalation of dental-benefit premiums, thereby making more mandatory dentistry available to more individuals. Second, it enables patients to have freedom of choice in treatment.
Properly designed and administered dental plans with an alternate benefit provision make dental benefit plans more attractive to purchasers, dentists and patients. An alternate benefit provision is both patient- and dentist-friendly.
Once again, we commend Dr. Christensen for bringing these differences to the dental profession’s attention.
