Dental/Vision/Hearing

[jdeasy]

No, your are confusing two different things. If the R&C is 100.00. The 80th percentile means 8 of 10 dentists will charge $100.00 or less for that procedure 90th percentile means 9 out of 10 dentists will charge 100.00 or less.

The plans do have different % for covered charges.

Thats the 100-80-50 part, so the plans will pay 100-80-50% of the charges bases on the percentile and R&C amount.

So long as you go to a dentist who charges in the middle of the range you should only be responsible for the plan % of the
covered charges.

We have a pretty big block of dental business and to be honest the 80-90% Percentile concern is way over blow and almost never causes issues. I have yet to see a plan that pays at the 50% percentile and I would never reccomend a broker sell that.

We may be saying the same thing with different terminology. I negotiated the dental contract with Delta dental and a major tire company covering over 150,000 workers and their families.

They used the 50 percentile to determine the R&C for their providers. They would pay thier providers whatever was the middle charge for that procedure. If 25% of dentents in an area cherged $75 for a filling and 25% charged $40, but 50% charged $60, they would pay their providers $60 for a filling.

 

[The Brokerage Resource]

We may be saying the same thing with different terminology. I negotiated the dental contract with Delta dental and a major tire company covering over 150,000 workers and their families.

They used the 50 percentile to determine the R&C for their providers. They would pay thier providers whatever was the middle charge for that procedure. If 25% of dentents in an area cherged $75 for a filling and 25% charged $40, but 50% charged $60, they would pay their providers $60 for a filling.

Yes I think we are saying the same thing. it's so easy to explain in person, and yet so hard to explain via text. I am a bit suprised to see a 50 percentile use by a carrier, but on group that size anything to get the rate down to where the employees
can afford it has to be looked at. Our groups are all less than
a 100 lives so the shelf product is the norm. Did the tire company self insure or was it fully insured, either way nice sale.

 

[somarco]

Delta Dental, Ameritas and a few others are known for low rates and low reimbursement percentiles.

 

[Guest]

Delta is $34.50 in Southwest florida and have a list of waiting periods and the benefits for the consumer is not that great.

 

[somarco]

The test of a "good" dental plan is what it will NOT pay.

Most folks look at dental the same way they do major med. If the price is right (low) and it has convenient copay's for routine things it gets a thumbs up. Even better if you can use any dentist.

The rubber meets the road on a major claim. That is when these plans fall apart.

The only ones that review a dental plan and are concerned about big things (crowns, bridges, root canal, orthodontia) are those with an immediate need.

I had a client call last week looking for dental for her mother. She needed a fair amount of major dental work and needed it ASAP.

I suggested the Humana DHMO plan. No waiting period. No deductibles. No annual cap. Solid plan.

Using Humana dentists was not an issue. She needed the work done.

The sale fell apart when she found out Humana requires you to keep the plan for 12 months. Seems she was fine with the $16 monthly premium, the network dentists, etc. but did not like the 12 month commitment.

She wanted the plan, get the work done, then wanted to drop it.

Calls like this really make my day . . .

 

[jdeasy]

Yes I think we are saying the same thing. it's so easy to explain in person, and yet so hard to explain via text. I am a bit suprised to see a 50 percentile use by a carrier, but on group that size anything to get the rate down to where the employees
can afford it has to be looked at. Our groups are all less than
a 100 lives so the shelf product is the norm. Did the tire company self insure or was it fully insured, either way nice sale.

It wasn't a sale, I was the head of the dental committee for the union while we were negotiating the contract. They were basically self insured. They used Delta Dental more for the services. They were paid on a cost plus basis. Best I remember they got 9% over costs to handle the paperwork and filing.

We had the best plan available with DD. We looked at competitor every 3 years but none could ever match or beat the deal with DD. Some could on a regional basis, but the plan had to be nationwide.

 

[arnguy]

Ritter carries UCT plans since somebody on here asked.

 

[AllGold]

I had a client call last week looking for dental for her mother. She needed a fair amount of major dental work and needed it ASAP.

I suggested the Humana DHMO plan. No waiting period. No deductibles. No annual cap. Solid plan.

Using Humana dentists was not an issue. She needed the work done.

The sale fell apart when she found out Humana requires you to keep the plan for 12 months. Seems she was fine with the $16 monthly premium, the network dentists, etc. but did not like the 12 month commitment.

She wanted the plan, get the work done, then wanted to drop it.

Calls like this really make my day . . .

Seems like I get a call like that (or lead) every week.