Payment For Dental Care Definitions
Capitation
It is defined as a fixed monthly/ yearly payment paid by a carrier to a dentist in a closed panel, based on the number of patients assigned to the dentist for treatment
Table of allowances
It is defined as a list of covered services that assigns to each service a sum that represents the total obligation of the plan to payment for such service but that does not necessarily represent a dentist’s full fee for that service
Payment For Dental Care Important Notes
1. Mechanism of payment
- Private fee for service
- Two party arrangement
- The most efficient way and structurally acceptable
- Only system under which some form of dental care is likely to be provided
- The system is flexible
- Post-payment plans
- Under this, patient borrows the money from a bank or finance company to pay the dentist’s fees
- Used by middle-class and low-income group
- Private third-party prepayment
- Payment for services is by some agencies such as insurance company
- Deductible
- The stipulated sum that the patient must pay toward the cost of treatment
- Coinsurance
- The patient pays a percentage of the total cost of treatment
- Group insurance
- Health insurance is offered to groups.
2. UCR fee
- U- Usual fee
- The fee usually charged for a given service by an individual dentist to private patients
- C- Customary fee
- A fee is customary when it is in the range of the usual fee charged by dentists of similar training & experience for the same service within a specific & limited geographic area
- R- Reasonable fee
- A fee is reasonable if it meets the above two criteria
3. Table of allowances
- It is defined as a list of covered services that assigns to each service a sum that represents the total obligation of the plan concerning payment for such service but that does not necessarily represent a dentist’s full fee for that service
- If the dentist’s fee becomes more than that assigned to that service by the carrier, the remainder will be collected by the dentist from the patient
Payment For Dental Care Long Essays
Question 1. Describe the payment plan for dental care.
Answer:
Dental care Private Fee For Service:
- It is a two-way arrangement of reimbursement of dental services
- Dentists prefer to practice under this arrangement
- It is the most efficient way of providing dental care
- It is an integral part of private practice
Dental care Advantages:
- Culturally acceptable
- Flexible
- Simple
- Provide dental care
Dental care Disadvantages:
- Not affordable to some patients
- Thus they are unable to receive dental care
Dental care Post-Payment Plans:
- Introduced in the late 1930s by local dental societies in Pennsylvania & Michigan
- Under this arrangement, the patient borrows money from a bank/ finance company to pay the dentist’s fee
- After the application is approved, the dentist is paid the entire fee
- The patient then repays the loan to the bank in the budgeted amount
Dental care Disadvantages:
- It was planned for low-income groups but was used by middle-income group
- Also, low-income patients find it difficult to accept the use of credit by lending institution
Dental care Private Third-Party Prepayment Plans:
Dental care Definition:
- It is defined as “payment for services by some agency rather than directly by the beneficiary of those services”
First Party: Dentist
Second Party: the patient
Third Party: finance
- Third-party refers to a private carrier such as an insurance company
Dental care Types:
- Deductible
- Co-insurance
- Group insurance
Dental care Plans:
- Commercial insurance companies
- Can be more selective
- Claim no obligation toward dental health
- Provide specific cash payment reimbursement
- Present an attractive total health package
- Do not conduct a post-treatment dental examination
Dental care Advantage:
Payment is quicker & hassle-free
Dental care Disadvantage:
- Do not encourage the utilization of professional services
- Allow for the profit margin
- Nonprofit health service corporation
- Delta dental plans: ensures that
- The care claimed & paid for has been provided
- It is of acceptable quality
- Blue Cross/Blue Shield
- These have adopted many of the cost control features pioneered by Delta plans
- Prepaid group practice
- Provides dental services on a prepaid basis
Types of Dental care :
- General practice groups
- Single specialty groups
- Multi-specialty groups
Dental care Capitation plans:
It is defined as a fixed monthly/ yearly payment paid by a carrier to a dentist in a closed panel, based on the number of patients assigned to the dentist for treatment
Dental care Salary:
Dentists in some group practices, those in the armed forces & those employed by public agencies are salaried
Dental care Advantages:
- Dentists will be largely free of business concern
- Attractive fringe benefits
Dental care Disadvantages:
Lack of financial incentive
Dental Care Public Program:
- Aimed at fulfilling the needs of specific groups of the society
- Sponsored by the government
Dental care Includes:
- Medicare
- Medicaid
- National health insurance
Payment For Dental Care Short Essays
Question 1. Delta dental plans (or) Third party payments (or) Mechanism/method of payment for the rental car
Answer:
Delta dental plans
- It is a legally constituted non-profit organization incorporated on a state-by-state basis & sponsored by a constituent dental society to negotiate & administer contracts for dental care
- They are usually subjected to the insurance laws of the state in which they are constituted
Dental plans Members:
- Dentist’s elected from the state
- Members from the world of finance, insurance, labor & consumer groups
Dental plans Activities:
- Ensure the quality of care provided
- Keep the program’s costs within its limit
- Ensures the care claimed & paid for has been provided
- Encourage the utilization of services
- Meet the demand for group purchase of dental care
Read And Learn More: Percentive Communitive Dentistry Question And Answers
Dental plans Advantages:
- Control of cost
- Quality assurance
- Wide support from dental practitioners
- The patients know they will not have to pay extra for their treatment
- Encourage all dentists to participate
Question 2. Medicare.
Answer:
Medicare
- Title XVIII of the Social Security Amendments of 1965 is the program known as Medicare
- It removes all financial barriers to hospital & physician services for all persons aged 65 & over, regardless of their financial means
- It was brought into being because the voluntary health insurance system was unable to provide adequately for persons over the age of 65
- Because the income of persons aged 65 & older is less, they have limited funds to spend on healthcare
- It is limited to those services requiring hospitalization for their treatment, usually a surgical treatment for fracture & cancer
Medicare Parts:
- Part A: Hospital insurance
- Part B: Supplemental medical insurance
- Both contain a highly complex series of service benefits available
- Both require some payment by the patient
Payment For Dental Care Short Question And Answers
Question 1. Capitation.
Answer:
Capitation Definition:
It is defined as a fixed monthly/ yearly payment paid by a carrier to a dentist in a closed panel, based on the number of patients assigned to the dentist for treatment
Significance Of Capitation:
- These plans are not purchased by specified groups but an individual can buy in
- Many of these plans offer only limited services
- Risk is low
- These plans are attractive where there is an oversupply of the dentist
Capitation Plans:
- Closed panel
- For beneficiaries of plans using closed panels choice of dentist is limited to panel members & the dentist must accept any beneficiary as a patient
- Open panel
- The beneficiary has a choice from among all licensed dentists & the dentist may accept/ reject any beneficiary
Question 2. Post payments.
Answer:
Post payments
- Introduced in the late 1930s by local dental societies in Pennsylvania & Michigan
- Under this arrangement, the patient borrows money from a bank/ finance company to pay the dentist’s fee
- After the application is approved, the dentist is paid the entire fee
- The patient then repays the loan to the bank in the budgeted amount
- Disadvantages
- It was planned for low-income groups but was used by middle-income group
- Also, low-income patients find it difficult to accept the use of credit by lending institution
Question 3. Fee for services.
Answer:
Fee for services
- It is the two-way arrangement of reimbursement of dental services
- Dentists prefer to practice under this arrangement
- It is the most efficient way of providing dental care
- It is an integral part of private practice
Fee for services Advantages:
- Culturally acceptable
- Flexible
- Simple
- Provide dental care
Fee for services Disadvantages:
- Not affordable to some patients
- Thus they are unable to receive dental care
Question 4. Table of allowances.
Answer:
Table of allowances
- It is defined as a list of covered services that assigns to each service a sum that represents the total obligation of the plan concerning payment for such service but that does not necessarily represent a dentist’s full fee for that service
- If the dentist’s fee becomes more than that assigned to that service by the carrier, the remainder will be collected by the dentist from the patient
Allowances Disadvantage:
Patients are often unaware that the plan may not cover them in full for dental care
Question 5. Blue Cross & Blue Shield.
Answer:
Blue Cross & Blue Shield
- These are non-profit health service corporation
- It is limited to services provided in a hospital
- It showed no enthusiasm for dental prepayment
- It has adopted many of the cost control features pioneered by Delta plans
Question 6. 90th percentile.
Answer:
90th percentile
- The percentiles of a set of data divide the total frequency into hundredth so that the 90th percentile is that value below which 90 percent of the observations lie
- When payment is made at the 90th percentile, it means that a payment of Rs 78 or their actual fee is paid to the participating dentists
Question 7. Medicaid.
Answer:
Medicaid
- It is the name given to title XIX of the United Social Security Amendments of 1965
- Its original intent was to provide funds to meet the healthcare needs of all indigent & medically indigent persons
- It is a joint federal-state program covering at least 3 basic services
- Inpatient hospital care
- Outpatient hospital care
- Laboratory & x-ray services
- Skilled nursing facilities
- Home health services
- Early & periodic screening, diagnosis & treatment (EPSDT) program
- Family planning services
- Physician services
- It is an extremely complex program
- Although the program has reached a large number of people, many needy persons are unable to receive dental care under it
Question 8. UCR fee. / Usual and customary fee
Answer:
U- Usual Fee:
The fee usually charged for a given service by an individual dentist to private patients
C- Customary Fee:
A fee is customary when it is in the range of the usual fee charged by dentists of similar training & experience for the same service within a specific & limited geographic area
R- Reasonable Fee:
A fee is reasonable if it meets the above two criteria
Question 9. Front-end payment.
Answer:
- It has connections to various card associations
- It supplies authorization and settlement services to the bank’s merchant
Payment For Dental Care Viva Voce
- Fee for service is the traditional form of reimbursement for dental services
- Potential patients not able to afford dental care the limited to private fees for service
- The third party in the private third-party pre-payment plans is called the carrier
- Front-end payment refers to deductible
- A public program aimed at the benefit of those over 65 years is Medicare
- A public program providing funds to meet the health care needs of all indigent and medically indigent people in Medicaid
- Robinhood practice-price discrimination can be practiced in a private fee-for-service mode of payment