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2.1 Sources of Patient Care Revenue
Private Pay Patients
Private pay patients are also known as “self-pay” or “out-of-pocket” patients.
Full
Pay
Although they represent a small percentage of safety net dental clinic
patients, some individuals who have no dental insurance and can
afford to pay full clinic fees may choose to receive care at safety
net dental clinics.
Sliding Fee Schedule or Other Reduced Fee Arrangements
Safety net dental clinics that serve patients who lack insurance
generally offer reduced fee care through a formal sliding fee schedule
or an informal arrangement in accordance with a patient’s
ability to pay. The extent to which care is discounted varies from
clinic to clinic. Managing the effect of uncompensated care that
results from charges and collections that are significantly less
than the cost of providing services is a major consideration for
financial sustainability.
Minimum
When minimum fees are offered, they are usually made available to
individuals with incomes below the federal poverty level (FPL).
Minimum fees may be a flat fee per visit, a flat fee per service,
or a low percentage on a sliding fee schedule (e.g., 10 to 20 percent).
Commercial Insurance
Indemnity
Indemnity refers to private insurance that generally comes through
an individual’s employer. Dentists are reimbursed on a fee-for-service
basis. Depending on the terms of the plan, patients may be responsible
for a deductible and co-payments. Typically, less than 5 percent
of safety net dental clinic patients are indemnity patients.
Managed Care—Preferred Provider Organization (PPO)
PPOs typically involve contracts between insurers and a number of
dentists who agree to provide care on a fee-for-service basis where
the fees are lower than the prevailing fees in the area.
Managed Care—Capitation
Dentists may enter into contracts under which they agree to provide
care for members of an insured group for a set fee that is paid
per plan member per month rather than per service provided. Capitation
plans often are synonymous with health maintenance organizations
(HMOs).
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