Types of Plans
Pelican Dental Concepts, by eliminating the middleman, maximizes patient choices and benefit dollars, while allowing the employer to maintain control. Dentists also embrace the approach because it doesn't interfere with the doctor-patient relationship.
All three of these basic models make the claims process extremely simple, fast, and low-cost.
Direct Reimbursement (DR)
The employee pays the dentist's full fee at treatment, submits a paid receipt or claim form to the employer or administrator, and is reimbursed for all or part of the fee, according to the plan design.
Direct Assignment (DA)
With DA, a dentist can accept payment from the plan administrator relieving the patient from paying fees up-front. After treatment the dentist files a simplified claims form with the administrator. The dentist is reimbursed according to plan design. The dentist may balance bill the patient for any part of the dental fee that is not reimbursed by the plan.
Direct Assignment Plus (DA+)
This plan differs from DA only in the handling of administrative fees. In DR/DA plans the fee (about 10-15% for a third-party administrator) is incorporated into the employee's monthly funding. In DA+ the patient and dentist instead pay a small co-payment at treatment, allowing 100% of plan funding to pay for dental care. Because the dental profession supports this freedom of choice dental plan, dentists are willing to share the expense of claims administration.