Paying for oral therapy, mandatory and elective

Most dental benefit or insurance plans have related payment for dental services primarily to payment for mandatory treatment. Patients should be advised that their plans might not pay anything for elective therapy. Most dental health maintenance organizations include very few elective items in their payment options. Some dental preferred provider organizations provide payment for elective therapy. I prefer to determine the patient's potential benefit payment for such elective care during the first appointment. Often, this knowledge will influence the patient's acceptance or rejection of therapy. Many dental business personnel have knowledge about potential benefit payments for elective care. If not, a phone call to the benefit company during the initial appointment is in order.

Complexity of treatment - Additional patient confusion can be related to the various levels of elective dental treatment. I will use as an example a patient with an edentulous mandible. The following options are available for treatment of an edentulous mandible (fees are average for the United States as reported by Atlanta Dental Consultants, and combined by the author:
• Leave the clinical situation without any treatment - $0
• Make a conventional remote lower denture - $800.00
• Make an overdenture over two implants and O-ring attachments - $3,300.00
• Make an overdenture retained by clips placed over four implants and a cast bar - $6,900.00
• Make a fixed-detachable hybrid prosthesis over six implants - $15,000.00

This hypothetical patient already has a denture that he finds totally unacceptable, but that the dentist judges to be of average quality. (This is not an uncommon experience; it is general knowledge that up to 90 percent of mandibular-denture wearers do not like their prostheses.) What is mandatory treatment or elective treatment in this example?

Since the patient on this case is dissatisfied with his lower denture, leaving the clinical situation without treatment is not an acceptable situation. The second option, of making a new conventional denture, undoubtedly would be a failure, based on the patient's previous treatment. In my prosthodontic practice, the third option in the example would become the mandatory therapy. The fourth and fifth options become the elective therapy. In such confusing situations, the dentist developing the treatment plan should educate the patient about why the treatment suggested is the lowest level of acceptable treatment for him or her. Third-party payers also need an explanation of this concept.

Summary and conclusion - A major portion of the dental treatment provided today for the American consumer is elective. Dental patients are confused when they receive diverse treatment plans from different dentists. It treatment plans for oral therapy are divided into mandatory and elective categories, dental patients experience far less confusion. In this article, I have discussed methods of implementing this form of treatment planning. Dividing treatment plans into categories of mandatory and elective care has advantages for dental patients, the dental team and the profession as a whole. Gordon J. Christensen, D.D.S., M.S.D., PH.D.

This article is a courtesy of JADA (the Journal of the American Dental Association)

• Elective Vs. Mandatory Dentistry
• Educating patients about elective dentistry