Navigating the world of dental benefits

Active engagement in advocacy empowers new dentists

As a member of the ADA Council on Dental Benefit Programs, Sara Ehsani, D.D.S., said new dentists should learn how to successfully navigate the world of dental benefits so they can better care for their patients and support the ADA’s advocacy efforts that in turn support them.

“New dentists should be aware that dental benefits play a crucial role in oral health care access for patients, and they need to familiarize themselves with the complexities of dental benefit programs,” said the alumna of the UCLA School of Dentistry, class of 2016.

The ADA has an online hub for ready-to-use dental insurance information that can help new dentists address and resolve even their most frustrating questions at ADA.org/dentalinsurance. Some resources cover the basics of dental insurance, including what a PPO plan is and how deductibles and co-insurance work.

Most PPO plans allow benefits for out-of-network dentists, but it’s wise for dental offices to verify patients’ coverage.

The most common deductible for a dental PPO plan is $50. Once patients meet their deductible, they may pay a coinsurance, or a set percentage of the plan’s allowed fee for the service they received. For example, the plan might cover 80% of the fee for a basic dental procedure, while the patient pays 20%.

Dr. Ehsani admits she did not receive specific training or instruction on handling dental benefits or insurance while in dental school.

During the Texas-based pediatric dentist’s tenure on the council, the ADA has successfully lobbied for the Ensuring Lasting Smiles Act, which requires all private group and individual health plans to cover medically necessary services resulting from congenital anomalies or birth defects.

“The act’s approval in the House of Representatives, with 310 bipartisan votes, highlights the ADA's commitment to positive health care changes,” Dr. Ehsani said. “Contributing to this effort has been a rewarding experience, knowing that the ADA is actively working towards ensuring access to essential services for individuals in need.”

The ADA also supported the passage of the Lower Costs, More Transparency Act in the House.

“The ADA's advocacy played a crucial role in emphasizing the significance of extending programs such as the Community Health Center Fund, the National Health Service Corps and the Teaching Health Center Graduate Medical Education Program,” she said.

Dr. Ehsani said the ADA's advocacy and legislative achievements often target improvements in oral health access, patient eligibility within dental benefit programs and overall support for new dentists.

“The ADA's advocacy positively impacts new dentists by influencing a professional environment where improved dental benefit policies enhance reimbursement rates, optimize administrative processes and promote fair treatment,” she said.

Dr. Ehsani encouraged fellow new dentists to educate themselves on how dental benefits impact their care.

“Active engagement in the ADA's advocacy efforts also empowers new dentists,” she said.