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To the editor: An article in the Dec. 9, 1996, issue of Business Insurance, "Dental Care Providers on Cusp of Managed Care" and a Perspective in that same issue by Carl Zimmerman, president and chief executive officer of Delta Dental Plans Assn., address new opportunities for companies to provide dental benefits to employees through managed care models of insurance. The American Dental Assn. naturally appreciates the attention given to this topic, as we continue our own efforts to see that more and more companies make access to quality dental care available to workers.

However, the articles omit an important piece of the "what's new in dental benefits" story. Recently, alternative models of dental benefit plans have been created for those employers who wish to avoid the expense of third-party insurance carriers or services corporations altogether and to ensure that employees receive the best quality care available. Many employers are aware that the expensive bells and whistles sold as "services" may be appropriate for medical plans, but are simply unnecessary for dental plans.

One of the most innovative models of dental benefits, for example, is direct reimbursement, a cost-effective, self-funded plan that can be administered either by the employer or by a third-party administrator. Unlike many other dental benefit plans, DR offers complete freedom to employees to choose their own dentists and to plan appropriately for treatment. The simplicity of DR eliminates claims hassles. Both employer and employee know what their financial obligations are.

Direct reimbursement is a straightforward accounting process: An employee visits the dentist of his or her choice, and receives and pays for treatment; the paid receipt is presented to the employer for reimbursement, based on a plan designed by the employer to meet both company and employee needs.

A DR plan is designed by the employer wishes to the amount the employer wishes to commit to the benefit. It is easy to write and doesn't require pre-payment of insurance premiums. The plan works well for industry giants as well as for small companies.

The ADA strongly supports and promotes the concept of direct reimbursement.

Gary Rainwater, D.D.S.


American Dental Assn.