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Direct Reimbursement Means Great Care

Shands Healthcare's decision means HR hears more positive feedback, and no coverage complaints.

October 17, 2001
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Shands Healthcare at the University of Florida provides innovative procedures and the highest standards of quality and service. It continually receives referrals from every county within the state. No wonder Shands is ranked among the best hospitals in the United States, according to "U.S. News Online."

"Shands Healthcare provides the ultimate in comprehensive care to its patients and, as an employer, offers the very best in complete dental coverage for its 7,500 employees," says Senior Director of Human Resources Ray Hoskavich. "That's why we added Direct Reimbursement (DR) to our existing plans."

For the past five years, Shands employees from its teaching hospital, four community hospitals, two specialty hospitals, and its equally renowned children's "hospital within a hospital" have come to know DR as the affordable dental plan with choices -- the right choices.

"Previously, our employees were so dissatisfied with our dental plans, they were a constant complaint directed to my office," says Hoskavich. "DR has been so well received that we no longer hear complaints, only positive feedback in our surveys."

Here's how direct reimbursement works: With a DR plan in place, an employee visits the dentist of his or her choice, receives treatment and arranges for payment, and later presents a paid receipt or proof of treatment to the employer for reimbursement.

Unlike most traditional insurance plans, DR reimburses employees based on dollars spent on dental care, not on the type of treatment received. Plan design varies according to a company's budget so that costs can remain under a company's control. Moreover, there are no predetermination or pre-authorization requirements, no usual, customary and reasonable fee determinations and typically no deductibles. By leaving all treatment decisions to dentists and patients, DR frees employers from employee complaints about limitations, exclusions, and hidden costs.

"In our case, DR also offers some exceptional hidden benefits," says Hoskavich. "DR has opened up communications between the University of Florida's College of Dentistry and our employees to alleviate fears that dental work will be done by students," he says. Employees now know that if they choose to visit the campus facility for dental care, they will be treated by the faculty, which includes some of the most qualified practitioners in the state.

Shands Healthcare opted for a self-funded DR plan with employees bearing the lion's share of the cost. The hospital helps underwrite the annual limit of $1,500 per employee, after which purchased insurance fully covers any remaining expenses.

"Our employees are satisfied with DR because they have choices, aren't limited to a panel of dentists and their networks, and because all services are covered," he says. "DR allows Shands Healthcare to offer comprehensive dental care at manageable prices," he says. "Most importantly, our employees are very satisfied."

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