Updated 5/20/25
Dental insurance often includes complex rules and restrictions. HMO plans require patients to see in-network dentists for coverage, while PPOs provide reduced coverage for out-of-network care. These plans also come with caveats like monthly premiums, waiting periods, and other limitations. As an alternative, direct reimbursement dental plans offer a simpler and more flexible approach to coverage.
The benefits of direct reimbursement plans
Direct reimbursement plans offer several advantages for both employers and employees. They are typically funded by the employer or employee, who sets aside a fixed annual amount based on a predetermined coverage limit. Employers benefit because they only pay for actual services used, rather than contributing to unused coverage.
These plans are not restricted to specific treatments—they can cover preventive care, prosthodontics, periodontics, and even cosmetic procedures like teeth whitening. Employees are free to choose any dentist, as direct reimbursement plans do not rely on provider networks.
Additional advantages include no premiums, deductibles, preauthorizations, waiting periods, or missing tooth exclusions—all common barriers in traditional plans.
Using a direct reimbursement plan
Patients follow a straightforward payment and reimbursement process when they use a direct reimbursement plan. They first pay their dental provider directly at the provider’s usual rate. Next, they submit an itemized receipt to a third-party administrator, insurer, or employer. They are then reimbursed for a percentage of the total dental expenses. Reimbursement is subject to the plan’s annual maximum, typically ranging from $1,000 to $1,500.
Although direct reimbursement plans differ from traditional dental insurance in how they provide coverage, they offer additional benefits, such as no premiums or waiting periods.
No matter what insurance plans your patients have, your practice needs a billing partner who ensures accuracy, timely reimbursements, and fewer headaches for your team. eAssist helps dental offices streamline collections, reduce claim issues, and stay financially healthy. Schedule a free consultation today to see how we can support your success.
