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Save Money on Dental Costs!

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HERE’S HOW PESC ADMINISTRATORS DELIVERS MAXIMUM VALUE AND COST SAVINGS

• Reducing dental fees
  • PPO dentists want to keep dental benefits affordable for employers and their patients so they are willing to discount their fees by 25% or more
• Incorporating appropriate benefits in dental plans
  • Many dental insurance plans have not been updated to cover new dental materials and techniques which are more cost effective treatments
• Using practicing PPO dentists as dental directors for utilization review
  • predetermination of benefits for expensive treatment to insure appropriate care and no surprises for patients regarding what will or won’t be covered
  • retrospective claims review to insure appropriate billing and compliance with plan benefits, limitations, and exclusions
• Utilization review saves employers and patients money by:
  • Eliminating unbundling of services (dentists bill plans for one two-film bitewing and ten intraoral periapical films for a total cost of $180; these services constitute one full-mouth Xray series which are paid at $86 saving the employer $94)
  • Insuring appropriate treatment (dentists submit for crowns on teeth where Xrays show that two-surface fillings are all that patients need; crowns cost $600 or more while two-surface fillings cost $74; employers save $526 on these claims and patients’ copayments are reduced from $300 to $14.80)
  • Pro rating payments for treatment (dentists bill for a full quadrant of scaling and root planning at a cost $130 but only treat 3 of the 7 teeth in the quadrant; payment is pro rated to 50% saving the employer $65)
  • Enforcing plan exclusions (dentists bill $95 or more for electric toothbrushes which are not covered benefits)
• PESC Administrators and PPO dentists work together to contain dental costs (eliminating the traditional antagonism between dentists and insurance companies)

 

 

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