Deciding on Dental Memberships: The Pros and Cons for Your Practice

Should Your Practice offer an In-house Dental Membership Plan?

 

We have all heard our patients say “does my insurance cover that? or “I cant afford that, maybe next year”. In recent years, dental membership/subscription savings plans have become increasingly popular among patients seeking affordable and convenient dental care. These plans, also known as in-house dental membership plans, offer a range of benefits for both patients and dental practices. One of the key advantages of dental subscription plans is that they provide a cost-effective way for patients to receive regular dental care without worrying about high out-of-pocket expenses. By paying a monthly or annual fee, patients can enjoy various preventive services such as cleanings, exams, and x-rays, as well as discounts on treatments like fillings and crowns. These in-house dental subscription plans allow patients to receive regular dental care at a fixed monthly or annual fee without the hassle of dealing with insurance companies or copayments. For our practices, the membership plans increase patient acceptance of treatment plans, ensuring a win-win for everyone.

 

 

Benefits for Patients

 

Dental subscription plans are often more flexible than traditional dental insurance plans. With the membership, there are no deductibles, waiting periods, maximums, claim denials, or pre-authorizations. Patients can receive all the treatment they want without the restrictions imposed by their dental insurance company and not leave any maximums on the table. This can be especially beneficial for individuals who do not have dental insurance or have limited coverage. Additionally, dental subscription plans often have no waiting periods or annual maximums, allowing patients to access care when needed most. This can be especially beneficial for individuals with ongoing dental issues or those requiring frequent dentist visits. Some plans may offer additional perks like emergency appointments or free consultations.

 

 

Limitations of the program

 

It is essential for patients to carefully consider the limitations of dental subscription plans before signing up. Some plans may restrict the types of treatments covered or require patients to pay additional fees for certain services. Additionally, patients should be aware that dental subscription plans are not insurance and do not provide the same protection against unexpected dental expenses. There are additional drawbacks to consider when it comes to dental subscription plans. One downside is that these plans typically only cover primary preventive care and may not include more complex procedures such as root canals or crowns. Patients may still need to pay out-of-pocket for these services, which can add up over time. Another disadvantage is that dental subscription plans are limited to the dental practice that offers them. If patients move or switch dentists, they may no longer be able to use their plan and could be left without coverage. This lack of portability can be a significant inconvenience for patients who value flexibility in their healthcare options.

 

 

How do dental subscription plans work?

 

Patients can sign up for a plan directly through their dental practice. They will then pay a monthly or annual fee (usually $300-$400 per year) directly to the office in exchange for a set of benefits outlined by the practice. More costly procedures, such as extractions and restorative services, can be discounted. Patients can then schedule appointments for covered services as needed without worrying about filing claims or meeting deductibles.

 

 

Benefits for the Practice and Team Members

 

Not only are the subscription plans beneficial to our patients, but the dental office can also reduce its dependence on insurance companies, grow its patient base, and increase treatment plan acceptance, significantly impacting the potential for increased revenue for the practice. As the practice increases revenue, it can offer its employees comparable salaries, bonuses, and benefit packages that would not otherwise be an option in an office struggling with overhead costs.

Dental offices must abide by their state’s Direct Primary Care Agreement Law. These laws provide guidance and restrictions for medical and dental practices to enter into contracts with their patients to provide services for an established fee.

 

When contemplating offering our patients a subscription/membership plan, the American Dental Association has provided the following guidance.

 

 

 

ADA Checklist and Considerations for Your In-Office Dental Plan

 

Use this checklist to help determine the critical steps before implementing your in-office dental plan. Addressing these items is an excellent way to begin developing your plan.

    1. Consult your attorney to determine how implementing this plan will affect your business.
    2. Send a promotional letter to patients without dental benefits.
    3. Determine the effective date for implementation of your new plan.
    4. Check with your state to determine if it considers these plans to be insurance and ensure that your plan complies with any state law.
    5. Review all your signed managed care agreements to determine if any clauses, such as the most favored nation clauses, may affect your in-office plan.
    6. Determine the annual fees, percentage discounts, and procedures that are covered.
    7. Have your attorney review your plan and the accompanying patient agreement.
    8. Start marketing your plan to the public and your uninsured patients. You may consider using social media or local radio and television advertisements and direct mail. You may also want to contact your local Chamber of Commerce for additional promotional opportunities. 

 

 

General Contract Considerations

 

These are some overarching considerations and are neither meant to be an all-inclusive list nor legal advice. Legal counsel should be consulted to develop a contract based on the plan design created by the practice, and can vary between practices. “Member” in the clauses below references the dental practice patient seeking to enroll in the in-office dental plan. Consider stipulating that:

 

    1. The dental practice retains the right to interpret any program stipulations.
    2. No refunds will be given if the Member terminates the plan before the end of the plan year.
    3. The annual membership fee must be paid in full before treatment.
    4. Membership benefits are not transferable, have no cash value, and may not be redeemed for cash.
    5. This insurance plan is not subject to the state Department of Insurance regulation.
    6. Plan membership cannot be combined with current dental insurance plans.
    7. No insurance claim will be filed for Members under this plan.
    8. The plan is for individual use only. It is not a group benefits plan.
    9. Each additional family membership must be paid at the time of the initial membership or at renewal time.
    10. Membership fees may be adjusted annually.
    11. Members are responsible for notifying dental practice of any address or contact changes.
    12. Missed appointment fees/penalties are ineligible for the membership discount.
    13. The total payment amount is due at the time services are provided. The fee discount will be void if full payment is not received during service.

 

 In addition to these general contract considerations, the contract must lay out the payment requirements to maintain membership in the plan. Some considerations include:

 

    1. Membership fee payment schedule.
    2. Consequences of missed payments.
    3. Guarantees for treatment fees related to the membership plan year.
    4. What services will be provided as part of the membership plan?
    5. What services will be provided at a discounted rate, and what level of discounts will apply?
    6. Whether the patient can cancel the plan and the consequences.
    7. Whether the practice can cancel the plan and the consequences.
    8. Will there be annual maximums on discounts?

 

 

Dental subscription/membership plans can be cost-effective and convenient for individuals seeking to prioritize their oral health. Dental membership plans also benefit the practice by attracting new patients, increasing patient compliance and acceptance of treatment and treatment plans, generating recurring revenue, and increasing the value of the practice.

While they may have some limitations and drawbacks, these plans can benefit those needing routine dental care. Patients and dental practices should carefully weigh the pros and cons before signing up for a dental subscription plan. A successful membership plan will align with the practice’s treatment philosophy, business goals, and ethical, compassionate patient care.

 

Maryanne Ferree RDH, BS, PHDHP

Maryanne Ferree, BS, RDH, PHDHP, CDIPC from Pittsburgh, Pennsylvania, is a registered dental hygienist with over 39 years of experience. She has ventured into many facets of dental hygiene, including clinical care, public health, and education. She is currently a clinical faculty member in the Department of Periodontics and Preventive Dentistry at the University of Pittsburgh School of Dental Medicine focusing her clinical teaching on Periodontal Instrumentation. She has been excited to step into the role of KOL and blogger to share her enthusiasm for infection control in the dental setting, OSHA compliance training, and periodontal disease therapy.

References:

Is an in-office dental plan right for your practice? American Dental Association. (n.d.-a). https://www.ada.org/en/resources/practice/dental-insurance/is-an-in-office-dental-plan-right-for-your-practice