There has been a marked increase in the availability of “discount card programs” for health, dental, vision, and prescription medicine services. Individuals typically purchase the cards on a “membership” basis for a monthly or annual fee. The cards provide access to a network of physicians, dentists, pharmacies, and other health professionals, who are described as offering discounted prices to cardholders.
The amount of the discount can vary by provider and service, but it typically runs between 5 and 50 percent. Some of the organizations offering discount card programs include Aetna, Ameriplan, Perfect Teeth, and Sam’s Club to name a few.
How do the cards work when paying for dental services?
➥ Persons purchase cards for amounts ranging from $6 to $100 or more (per month, per year, per person, per family - the details vary).
➥ Patients receive services by participating dentists at discounted rates.
➥ Typically, there are no restrictions on services such as cosmetic dentistry or implants, but an enrollment period of one year is common.
➥ Patients pay the dentist directly according to the pre-arranged discount price. Payment is typically required at the time of the service.
➥ No claim forms are used and no referrals are required from other providers.
➥ Discount cards are not insurance and are therefore unregulated.
Who provides services under these plans?
Dentists who have signed contracts with standard dental insurance plans, preferred-provider plans, dental- maintenance organization plans, and other networks may be surprised to learn they are also listed as providers under a discount card plan they are unfamiliar with. Administrators of dental networks may “contract their networks out” to other programs. Dentists also may join on their own in order to provide discounted fees to individuals who otherwise might be unable to pay for treatment. For some dentists, it can be a method of having patients pay cash at the time of treatment.
How do the discount cards "work" with standard insurance plans, PPO, or other managed-care or benefit plans?
The simple answer is they usually don’t. Typically, patients with indemnity insurance, a DMO, or a PPO plan will not see any additional savings as the result of purchasing a discount card. Discount card Web sites frequently state that members should always use their regular dental plan for covered services and then use the discount card for the remaining portion of the bill. However, in the majority of situations, dentists may not offer discounts on copayments or deductibles. In fact, offering discounts on copayments - or waiving copayments or deductibles - is almost always considered to be fraudulent. In most states, the patient must not have any other insurance coverage for discount cards to be used legally.
Coordination of plans is subject to state regulations. Generally speaking, standard insurance plans which coordinate with any type of managed care typically will only pay toward the actual fee charged to the patient, regardless of the “regular” fee of the dentist.
For example: Dr. Jones’ fee for a D2750 - Crown-Porcelain Fused to High Noble Metal - is $850. Dr. Jones is a contract provider for XYZ Managed Care Plan. An XYZ Managed Care plan patient pays Dr. Jones $250 for Code D2750, not $850. An indemnity plan in the secondary position (meaning any plan that does not cover the patient directly) will normally consider only the $250 fee actually charged to the patient for any additional benefits, thus paying only $125. If the indemnity plan is in the primary position, the claim must state the existence of a secondary plan, so the primary plan may also pay less.
Ideally, the appointment coordinator should ask patients if they have any insurance plans or discount cards as part of the normal phone conversation prior to setting up a first appointment. If the dentist does not work with a certain insurance plan or honor a certain discount card, this can be explained to the patient before the first visit. Patients often purchase discount cards without knowing who their providers might be. This is another good reason for dentists to present a treatment plan and written estimate in advance of treatment. A discussion of fees and the patient’s financial responsibility are always important for both the dentist and the patient.
Carol Tekavec, CDA, RDH, is the author of the Dental Insurance Coding Handbook Update CDT-2005. She is the designer of a dental chart and is a lecturer with the ADA Seminar Series. Contact her by phone at (800) 548-2164, or visit her Web site at www.steppingstonestosuccess.com for more details about the new code handbook and her patient brochure, “My Insurance Covers This ... Right?”.