The Dental Service Corporation 56% 5mm lag?! 33% ~51; U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service JHE DENTAL SERVICE CORPORATION Organization and Development \n—m By George E. Mitchell, D.M.D., M.P.H. and Ferris M. Hoggard, Ir. US. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Ly ~ g. Public Health Service Division of Dental Public Health and Resources ' Washington, DC. 20201 (ii ‘5‘“; “EN“ P V "p¥“fl v‘d‘?’ C Public Health Service Publication No. 1274 1965 United States Government Printing Oflice Washington, DC. 20402 m 33 PREFACE The principle of prepayment as it applies to the financing of hospital and medi— cal care costs is widely accepted in the United States. More than 145 million Americans had some type of prepaid hospital or medical care coverage by 1964. The prepayment of dental (care costs, however, is not so common. By compari- son, only a little more than 114 million persons were covered under some type of prepaid dental care plan. Several factors are responsible for the slow development of prepaid or insured dental health plans. Although dental diseases are the most prevalent of all chronic diseases affecting mankind, the general population does not fully ap- preciate the value of oral health as a part of total well-being. With limited funds for the purchase of health services, individuals as well as unions and other organized employee groups have had to restrict their purchases of health insurance to protection against the more dramatic and potentially catastrophic expenses of medical, surgical, and hospital services. This scarcity of available funds had contributed to less public demand and a lack of acturial data and ex- perience. For these reasons, the dental profession and the insurance industry have not made prepaid dental care more widely available. As a result, groups which have acquired funds for prepaid dental care have had, until recent years, a somewhat restricted choice in the types of plans they could purchase. Since World War II, organizations such as the American Dental Association, State and local dental societies, and labor unions, as well as public health officials, have shown more interest in improving the level of dental care in the United States. Increased interest and more available money for meeting the cost of health care needs have been responsible for various plans designed to make dental care available to more people. Four main approaches to the group purchase of dental care are now in use: 1. Dental service corporation plans These service type plans are administered by professionally sponsored nonprofit organizations. These corporations contract with purchasing 401 iii \2 #2 groups to pay private dentists for services provided to eligible subscriber members. Under these plans the subscriber may select any dentist of his choice to care for his dental needs. 2. Group practice plans These are service type plans contracted between purchasing groups and group practices conducted by two or more dentists sharing office facilities, personnel and costs. Dental services are provided to plan beneficiaries in one or more dental facilities where the choice of dentist is limited to the dentists comprising the group practice. 3. Union, employee association or employer plans In these plans the purchasing group contracts with one or more dentists to provide services in a facility equipped, owned, and operated by and for the purchasing group. 4. Insurance plans These health plans are typical insurance policies written by commercial insurance carriers and indemnify or reimburse subscribers for part or all of the cost of dental services performed by their private dentists. Each type of plan has been operated successfully and each hasitsplacein the field of dental prepayment. A recent innovation in prepayment has been the flin§g§9d,.,gr..§.§lf;flnjfl' istered plan. Under this plan the purchasing group makes direct payments for all or part of the cost of a member’s dental care without using the services of a third party or administrative agency. The group handles all claims, as- sumes the risks, and acts as its own insuring agent. The dental service corporation approach has attracted much public and profes— sional interest as a method of purchasing dental services on a prepaid basis. Most State dental societies have considered forming service corporations to administer dental programs within their areas. Twenty-two corporations have been established so far and nine of these are already servicing prepaid group dental care contracts. Enough experience has now been gained to establish guidelines for the forma- tion of a dental service corporation. This publication is designed to meet the need for a broad outline of the procedures involved in organizing and develop— ing a dental service corporation. It provides basic information on the plan— ning, incorporation, and operation of this type of organization. iv II. III. IV. VI. TABLE OF CONTENTS INTRODUCTION A. What Is a Dental Service Corporation? ______________________________ B. Why a Dental Service Corporation? _________________________________ C. Dental Service Corporation Potential ________________________________ DENTAL ASSOCIATION PLANNING . Study Committees ________________________________________________ Legal Assistance __________________________________________________ Policy Statements ________________________________________________ Initial Financing __________________________________________________ . Methods of Payment ______________________________________________ F. Membership Support ______________________________________________ INCORPORATION A. Legal Considerations _______________________________________________ B. Corporate Instruments ____________________________________________ C. Dental Association Actions _________________________________________ D. Licensing and Regulation __________________________________________ ORGANIZATIONAL STRUCTURE A. Board of Directors ________________________________________________ B. Officers __________________________________________________________ C. Administrative Staff _______________________________________________ D. Consultant Services _______________________________________________ E Advisory Committees _____________________________________________ RECORDS AND REPORTS A. Record Requirements ______________________________________________ B. Record Systems Design ____________________________________________ C. Record Prototypes ________________________________________________ OPERATIONS A. Cost Estimating __________________________________________________ B. Contract Negotiating ______________________________________________ C. Contract Servicing ________________________________________________ D. Communications __________________________________________________ muow» APPENDIXES A. Principles for Determining the AcCeptability of Plans for the Group Pur- chase of Dental Care ____________________________________________ B. Status of Dental Service Corporations and Related Planning in the United States—July 1, 1964 _____________________________________ C. Existing Dental Service Corporations ________________________________ D. Selected Examples of Dental Service Corporation Records and Reports- E. Selected References on Dental Service Corporations ___________________ Page 13 14 14 15 15 19 19 2O 23 24 26 26 29 31 33 35 63 I. Introduction In 1949, the American Dental Association adopted a policy statement which ex— pressed its objectives in dental health programs at the national, state, and local level. In the section on a national dental health program, it stated: “Voluntary prepayment and postpayment plans consistent with sound experience should be developed as rapidly as possible.” The Association’s House of Delegates later adopted a statement to provide the dental profession with criteria for the evalua- tion of prepayment plans. In 1957, the dental service corporation was approved by the American Dental Association as an acceptable administrative mechanism for the financing of dental care costs in these words: “Constituent societies which may anticipate the development of sufficient demand for organized plans for the group purchases of dental care should give consideration to the establishment of a dental service corporation but only after consultation with competent legal counsel.” A. What Is a Dental Service Corporation? The dental service corporation has been de- scribed as organized dentistry’s response to the growing demand for dental care on a prepaid basis. The American Dental Association has stated that “a dental service corporation should be a legally constituted not-for-profit organization sponsored by a State dental society to negotiate and administer contracts for dental care.” Although the dental service corporation is a legal entity separate and distinct from the sponsoring dental society, its organizational policies are determined by members of the den- tal profession. It receives guidance from the profession through the dental membership of its board of directors. Thus it is often de- scribed as a business arm or fiscal agency of the , sponsoring dental association. A dental service corporation has these features: 1. It is professionally sponsored; 2. is nonprofit in operation; 3. permits participation by all licensed den- tists witbin tbe State; 4. provides benefits on a service basis; allows freedom of cboice for botb tbe patient and tbe dentist. E" \ in“ B. Why a Dental Service Corporation? Dental societies have established dental service corporations for several reasons: 1. 2. They ofier a means whereby organized dentistry can discharge its professional obligations to the public; help to preserve the traditional solo prac- tice of dentistry and the dentist-patient relationship; provide an eflective method for extend- ing dental services to more people; raise the general level of oral health by making quality care more widely avail- able at a reasonable cost. C. Dental Service Corporation Potential The corporation : 1. provides a means of budgeting for den- tal care that reduces the financial barrier to obtaining it; assures professional guidance in develop- ing dental plans and the delivery of dental care of a quality consistent with prevailing standards of dental practice; . provides a maximum return to the sub- scriber for each premium dollar ex- pended through the use of the nonprofit principle of operation and low admin- istrative costs; 4. employs the services of many dentists engaged in independent practice through- out a State, thus meeting the needs of large groups dispersed over a wide geo- graphic area; . adjusts its plans to meet consumer needs and resources and can thus administer programs for a variety of specific groups; provides a means for eflective dental health education programs to encourage utilization and good dental health prac- tices. II. Dental Association Planning A. Study Committee In planning a dental service corporation, the sponsoring dental group should first evaluate the need for the organization. It should then determine the identity and size of the potential market for prepaid group dental care programs. Preliminary studies and planning should be as— signed to standing committees of the dental as- sociation such as the Dental Care Committee, or the Commit-tee on Dental Health. Special com- mittees may be appointed for this purpose such as a Group Purchase Committee or a Prepaid Dental Care Committee. These committees serve as the preliminary pol- icymaking agency for the sponsoring profes- sional group. The committees will be able to assess the need for organized efl’orts to provide more dental care by reviewing data on the den- tal needs and utilization patterns of population groups. Through informal discussions, they can gage the extent of the prospective consumer groups’ interest in purchasing dental care for their membership. Committee members should become thoroughly familiar with all aspects of prepayment and health insurance through study courses and a review of the literature. B. Legal Assistance Early in the planning stages, the services of competent legal counsel should be retained. Le- gal counsel should determine the authority and requirements for incorporation and provide ad- vice on the type of corporation best suited to the needs of the sponsoring group. He can also assist in developing the corporation’s articles of incorporation, constitution, and bylaws. At this stage, the type of corporation desired should be decided upon. Whether it is to be a profitmaking, a not-for-profit, or foundation type of undertaking is a decision which, to a large extent, will be determined by the require- ments and restrictions for existing legislation as they apply to the health service and insurance fields. Legal counsel should thoroughly investigate the limitations as well as the poSSi'ble advantages of incorporating within existing insurance, den— tal practice, or business corporate laws. Special legislation of the enabling type may be required or amendment of the State dental practice act may provide the vehicle for incorporation. C. Policy Statements On the basis of recommendations of the working committees and legal counsel, one of the first ac- 76 3—660 0—65—2 tions should be the development of a statement of the dental association’s policy on the cor- 3 poration. In addition, a separate policy state- ment should be drafted for the guidance of the new organization. 1. Dental Association Policy Statement Subjects appropriate for the dental association’s policy statement might include: a. Definition of the objectives of the corporation. b. Identification of policy matters deter- mined by the service corporation and those retained by the society. 0. Suggested method of administration for the service corporation. (1. Designation of the incorporators of the corporation. e. Development of standards for the guid- ance of the service corporation in such areas of operation as: (1) Dentist participation agreements. (2) Methods of payment. (3) Quality assurance programs. (4) Grievance procedures. 2. Dental Service Corporation Policy Statement The policy statement developed for the service corporation is designed to serve as a guide for the actions of its directors, officers, and em- ployees. This statement should provide for: a. Definition of the purposes or objectives of the service corporation. b. Review, approval or rejection of pro- posed plans, contracts and interagency relationships. c. Delegations of authority by the govern- ing body and officers to corporation employees. (1. Review and initiation of action on re- ports, budgets, audits, and other state- ments. e. Other actions to insure the success of the corporation. D. Initial Financing Enough working capital to cover initial pur- chases and operating expenses for a predeter— mined period must be raised. The minimum amount of original capitalization is often deter— mined by the legal authority under which in— corporated. Sources of funds for initial capi- tal include: 1. Interest or noninterest-bearing loans from ban/es, individuals, or the sponsor- ing dental association. 2. Reimbursable, as well as nonreimburs- able, membership fees paid by partici- pating dentists. 3. Income derived from special levies made upon the membership of the sponsoring dental association. 4. Grants from the sponsoring dental asso- ciation. E. Methods of Payment The dental association planning committee should determine the method to be used in pay- ing participating dentists. As a rule, service corporations employ one of the following fee systems: 1. Fixed Fee Schedule Under this type of schedule, the dentist charges his usual fee for a service up to the maximum allowed by the fee schedule. It reflects the 4 prevailing rates for dental services in an area and generally represents full. payment for services. These rates should be set at a level consistent with accepted standards of practice. Two possible bases for fixed fee schedule deter— minations are: a. Existing dental fee schedules established and used in the State by the Veterans Administration, the Departments of Public Welfare and Vocational Rehabil- itation, and fee-for-service studies made by the State dental association. b. A special survey of charges for dental services of all, or a sample, of the den- tists in a State. A rounded value closest to some statistical measure—such as the mean, median, mode or third quartile— of each service in the proposed fee schedules may then be used as the pat- tern for a master schedule. If this method is employed, the Bureau of Eco- nomic Research and Statistics of the American Dental Association will assist in the design of dental fee questionnaire forms and provide technical advice and assistance in conducting the survey. The Bureau will also analyze the results and prepare a summary report of the survey without charge. 2. Schedule of Allowances Under this system of payment, the dentist charges his usual fee for service, but the service corporation assumes responsibility only for that portion of the charge which is listed as the dollar allowance. The patient is responsible for any amount in excess of the listed allowance. Existing fee schedules or data collected in a fee survey may provide the basic information for developing a schedule of allowances. Usually, the allowance is set at 20—30 percent below a median fee so that minimum fees charged by individual dentists will not be affected. 3. N onscheduled Fees No fee schedule is employed under this system. However, each participating dentist is required to submit a listing of his usual and customary fees to the corporation and he is paid for serv- ices performed at these rates. The fees listed by the dentist generally are applicable for a full year. Each dentist may make annual adjust- ments in his fees. N o matter what method is used in determining equitable, acceptable, and reasonable fees, pro- vision should be made for periodic review and revision to reflect changes in prevailing rates and costs of operation. F . Membership Support An effort should be made to enlist the support of members of the profession in the planning and organization of the service corporation by: 1 . publishing articles in dental journals and newsletters designed to familiarize the membership with prepayment; 2. circulating materials of special interest to the membership to inform them of current developments; 3. meeting with local and district dental so- ciety groups to report the committee’s ob- jectives and activities; 4. conducting workshops on prepayment for the education of the membership. III. Incorporation A. Legal Considerations The study committee of the dental association should review, with legal counsel, the restrictive provisions of the State dental practice act as they might apply to the formation and opera- tion of a dental service corporation. The com- mittee should also study the applicability of existing corporation and insurance statutes. 1. Dental Practice Act The dental practice acts in many States pro— hibit the corporate practice of dentistry. How this prohibition applies to service corporation operations should be thoroughly investigated. Interpretation of such prohibitions usually has been that the dental service corporation is not engaged in the corporate practice of dentistry since it does not actually provide services. It acts rather as administrative agent between participating dentists and groups of subscrib- ers. The participating dentists retain full legal responsibility for their work. Some State dental practice acts prohibit the practice of dentistry under a name other than that under which a dentist is licensed. Whether such a prohibition might apply to dentists who contract with the dental service corporation as participating dentists is another legal consider— ation. Generally, it has been ruled that partici- pation in prepayment plan activities does not constitute a violation of this prohibition. How— ever, in some States dental practice acts have been amended to specifically exempt service corporation activity from this limitation. 2. Corporation Law: Legal authority to incorporate may be sought either in existing profit or nonprofit corporate laws or through the enactment of special ena— bling legislation. a. Profit and Nonprofit Corporate Laws (1) Nonprofit Corporation Laws— Incorporation under existing non- profit corporate laws is the least expensive and often the favored method of forming a dental serv- ice corporation. This type of organization is in close accord with the public interest objectives of a service corporation. If the purposes and objectives of the corporation are properly stated and the initial period of opera- tion is to be on other than a risk basis (i.e., “cost plus” contracts), incorporation as a nonprofit or- ganization is possible. Corpora- tions formed under nonprofit laws generally enjoy more favorable tax treatment; however, exemp- tion from taxation is not granted automatically. (2) General Corporation Laws—As a rule, incorporation under general corporate laws is avoided because of the certainty of taxation to which general corporations are subject. (3) Health Service Corporation Laws—In some States, the laws that govern the establishment and operation of nonprofit health serv- ice corporations include dentistry as a health service. Other health service corporation laws apply only to hospital and medical care services. Under the former, the dental service corporation may be able to incorporate; while in the latter, amending the health serv- ice corporation statute may pro- vide the means for incorporation. b. Special Enabling Legislation A well-drafted enabling act eliminates all doubt of the legality of a service corpora— tion and insures against the possibility of litigation. Although such special permis- sive legislation is time consuming and ex- pensive, it is probably the most desirable. Of the 22 dental service corporations estab- lished by December 31, 1964, 10 had ob- tained special enabling legislation and 12 were incorporated under existing statutes. Enabling legislation had been enacted in nine additional States although dental service corporations had not been formed. In 16 other States and the District of Columbia, enabling legislation was either under study, in the process of being sub- mitted or would be required before incor- poration. Only three States and Puerto Rico reported no activity in service corpo- ration planning. 3. Insurance Laws and Regulations Health service corporations, whether operated on a profit or nonprofit basis and whether in- volving an insurance risk or not, are subject to regulation by the State agency responsible for administering insurance laws. In planning the service corporation, it is wise to determine the extent to which the proposed corporation’s op- erations may be subject to the regulatory au- thority of the State Insurance Commissioner. The provisions of these laws and regulations may be divided into three groups: a. Protective Regulations Most insurance laws require some guarantee of benefits to protect subscribers. Guaran— tees may consist of fixed cash reserves or other adequate underwriting features. As a rule, these regulations will also require approval by the insurance commission of both the rate and benefit structure of all plans offered by the dental service corpora- tion. b. Operating Limitations Many insurance laws limit geographic areas of operation, specify the minimum number of participating dentists required, fix the percentage of premiums that may be re- tained for administration, and regulate the investment of corporate funds. c. Reporting Requirements Insurance statutes will usually require an- nual reports on the financial condition of the corporation and identification of the current officers, management and govern- ing body. Additionally, such statutes gen- erally convey the right of inspection of cor- porate records to the insurance commis- sioner. 4. Code of Ethics Although the codes of ethics of professional or- ganizations do not have the effect of law, they receive strong consideration in the development of professionally sponsored service corporation plans. Ethical prohibitions against profes- sional participation in some of the normal func- tions of a service corporation, such as advertis- ing and plan promotion, should be clearly defined. B. Corporate Instruments Based on the proposed objectives, functions, and method of service corporation operation, the legal documents necessary for incorporation should be prepared by legal counsel. Other in- 8 struments required in the performance of the corporation’s functions should also be drafted. These include: 1. Articles of Incorporation This instrument, in effect, is a contract between the State, the incorporators, and the corporation and may be considered the corporation’s charter or official recognition as a legal entity. The fil- ing of such articles with the appropriate State agency (insurance commission, commission on insurance and banking, secretary of state, State securities and corporations commission, or similar regulatory body) is the initial legal step toward the formation of a corporation. Typi- cally, the articles include: a. A reference or citation of the statute un- der which incorporation is proposed. b. A statement of the name of the corpora- tion, the address or principal place of business and identification of the cor- poration’s registered agent. 0. A statement of the objectives (or pur- poses) for which the corporation is being formed. (1. Identification of the number, and names, and addresses of each of the incorpora- tors or members of the first governing body. e. Indication of the period of duration or term of existence of the corporation. 1’. ProvisiOn for the formulation of bylaws under which the corporation is to func- tion. 2. Bylaws This document is a detailed statement of the rules and regulations that the corporation estab- lishes for its internal government and adminis- tration. Bylaws generally include provisions for: a. Meetings Specifies the time and frequency of reg- ular and special meetings of the governing body and membership and prescribes ad- journment procedures. Sets minimum quo- rum requirements and voting procedures. May provide for voting by proxy. They also identify the rules of parliamentary procedure to be followed in conducting cor- porate meetings. b. Management (1) Board Members—Prescribes the number, method of selection, term of office, authority, duties and responsibilities of the governing body and its officers, and sets their compensation, if any. (2) Corporate Members—Identifies the membership of the corpora- tion, defines membership require- ments, and states their privileges, responsibilities, and powers. (3) Employees~Provides for the em- ployment of personnel to conduct the day-to-day business of the cor- poration, prescribes their duties and functions, defines the limita- tions of their authority, and pro- vides for their compensation. (4) Finances—Provides for the use or disposition of corporate earn- ings, if any, and prescribes the method of distribution of the cor- poration’s assets in the event of dissolution, if not already pro- vided for in the articles of incorpo- ration. c. Committee Structure Provides for the establishment of standing and special committees to facilitate the conduct of ‘ corporate affairs. Prescribes the composition, method of selection, func- tions, and authority of such committees. (1. Amendment of Bylaws Describes the method and requirements for amending the bylaws. e. Corporate Seal Provides for the design and use of a cor- poration seal to adequately identify legal documents and actions of the corporation. 3. Participating Dentist Agreements In many States, the legal authority under which the corporation is formed will prescribe the minimum number or percentage of the li- censed dentists who must sign contractual agreements to provide services. This require- ment is designed to assure that dentists, in suffi- cient numbers, will be available to provide services to subscribers in accordance with the provisions of group dental care contracts. This requirement is generally met through the exe- cution of participating dentist agreements, or 9 contracts between individual dentists and the service corporation. Such agreements, or con- tracts, state the responsibilities, duties, and authority of both the dentist and the corpora- tion. a. The dentist agrees: (1) to delegate authority to the dental service corporation to act as his agent in offering his services for group purchase; (2) to accept payment from the serv- ice corporation for professional services in the amount and manner prescribed in the service contract; (3) to abide by the rules .and regula- tions of the service corporation. b. The corporation agrees: (1) to pay dentists promptly for pro- fessional services rendered in ac- cordance with service contract provisions; (2) to honor the special relationship between a dentist and his patient. 4. Service Contracts These documents are legal agreements between the service corporation and a subscriber or a group of consumer subscribers for the purchase and provision of dental services. Service con- tracts specify the benefits, limitations, costs, and method of operation of the dental prepay- ment plan. Such contracts usually consist of the following elements or a combination thereof: a. The date of execution and identification of the parties to the agreement. b. Definition of contract terms and their use. c. A statement of the conditions of eligibil- ity and enrollment and method of cer— tification of eligible enrollees. d. A listing and description of the type and extent of benefits covered. e. Identification and description of condi- tions and applicability of benefit limita- tions and exclusions. f. Specification of the amount, frequency, and method of payment of premium and other contract costs. 10 g. A description of required notices, proof of claims, and claims payment proce- dures. h. Designation of consumer group obliga- tions: (1) to certify the eligibility of sub- scriber members; (2) to obtain the consent of subscriber members for the release of treat- ment information; (3) to pay premiums and/ or other contractual costs when due and in accordance with the terms of the contract. i. Enumeration of corporation commit— ments: (1) to enter into participation agree- ments with dentists in sufficient numbers to assure the availability and delivery of contracted serv- 1ces; (2) to operate an audit or review sys- tem which will assure service of a high quality; (3) to maintain service and cost ac- counting records systems; (4) to make prompt payment of claims for dental service benefits pro- vided; (5) to provide periodic reports to the consumer group of utilization ex- perience and service costs. j. Provision for the settlement of griev- ances. k. Provision for contract amendments, re- newals, and terminations. 1. Provision of conversion privileges when indicated. In. Date of execution and signatures of au- thorized representatives of the contract- ing parties. Most service contracts are tailored to meet the requirements of the contracting group. As experience is gained, more corporations are formed, and contracts of a national or multi— State nature are developed, more standardiza— tion of contracts may be anticipated. C. Dental Association Actions Based on the findings and recommendations of the study committee and legal counsel, the board of trustees or other governing body of the den- tal association may proceed with the formation of the service corporation. Authority to make such a decision may be vested with the govern- ing body of the dental association or it may be necessary to obtain the approval of the associa- tion membership. Regardless of the procedure followed, it will be necessary to seek oflicial re— view, approval and action on a number of con- siderations such as: 1. Tbe acceptance of tbe articles of incor- poration and bylaws as submitted by legal counsel. 2. Tbe appointment, election, or designa- tion and qualification of an initial board of directors or trustees to govern and manage tbe business of the service corporation. 3. Tbe provision of sufiicient funds to begin operation. 4. Tbe granting of official autbority to file papers for incorporation and to make application for a license to operate. D. Licensing and Regulation 1. Application for License The last major step in the process of incorpora- tion is to make application to the proper licens- ing agency of the State government for a certificate of incorporation and/or a license to operate. The State agency that will exercise regulatory authority over the corporation’s activities will determine the requirements, re- strictions, and regulations under which the service corporation may operate. a. Licensing Authority Licensing and regulatory agencies vary from State to State. In most States, it is one of the following: ( 1) Office of the secretary of state or attorney general. (2) State corporation and securities commission. (3) State commission on banking and insurance. (4) State insurance commission. b. Application Documents Applications for certificates of incorpora- tion generally require the filing of copies of the following documents with the licensing authority: (1) Copies of the articles of incorpo- ration. (2) Copies of the bylaws. (3) Copies of each proposed contract between the corporation and den- tists, if used. 763—660 0~65———-3 (4) Copies of each proposed service contract between the service cor- poration and consumer groups. 0. Application Information Licensing applications usually require such information as: (1) The name, location, chief place of business, and object for which the corporation is being formed. (2) A statement defining the geo— graphic area of coverage, services to be rendered, and rates to be charged. (3) A list of the oflicers and directors who will manage the afi'airs of the corporation, their tenure of office, and how they are elected or appointed. (4) A corporation financial statement which Will include the amount and source of corporate funds and the terms for repayment of outstand- ing loans and other financial 0b- ligations, if any. 2. Required Reports In addition to the original application for licensure, most State regulatory agencies will require subsequent reports. These reports gen- erally are made on an annual basis and con- sist of: a. A statement of the financial condition of the corporation. 11 (2) Assurance of the performance of contract obligations through in- surance company underwriting, guarantee bonding with a surety company, or cash deposits with a b. A listing of the names and addresses of the current officers and directors of the corporation. c. A report of the number of subscribers and participating dentists. 3 . Regulations Once licensed, the service corporation is subject to regulation in a number of areas. Some of these regulations are: 12 a. Regulations which pertain to changes in corporate structure or policy: (1) Changes in the articles of incor- poration or bylaws. (2) Changes in corporate membership or management. (3) Changes in major corporate State regulatory authority. (:1. Regulations for the establishment of operating limitations include those for: (1) establishing the geographic bound- aries within which the corpora- tion may operate; (2) reviewing and approving pre- mium rates and rate structures; (3) limiting retention rates or admin- istrative overhead allowances; (4) regulating the investment of cor- porate funds. functions. e. Regulations for the suspension of a cor— b. Regulations Which specify initial capi- poration’s license and dissolution include talization, reserve and contingency fund those for: requirements. (1) operating fraudulently; 0. Regulations for the protection of (2) violating or failing to fulfill any subscribers: (1) Contract agreements with partici- provision of the State code per— taining to the operation of the pating dentists in sufficient num— corporation; bers to assure fulfillment of serv- (3) inability to fulfill contractual ice commitments. obligations. IV. Organizational Structure of a Dental Service Corporation Although the organizational structure and general functions of the service corpo— ration’s governing body, officers, and administrative staff are provided for in the bylaws, their specific functions, duties, and responsibilities should be determined. A. Board of Directors The governing body of the corporation, most often a board of directors, is the policymaking body of the service corporation elected by the corporate membership to direct corporate functions. 1. Size and Composition a. State corporation acts may or may not specify the number of members of a cor- poration’s board. b. Members of the board should be suffi- cient to represent the dental profession, the lay public, and consumer groups. 2. Qualifications of Members a. As a rule, State corporation acts do not prescribe the qualifications of board members except to require that they be of legal age and residents of the State. b. Any special qualifications which might be required of board members, such as corporate membership, should be writ- ten into the bylaws. 3. Method of Selection a. The original board of directors may be appointed or elected by the governing body of the sponsoring dental associa- tion. b. Later, members of the board should probably be elected by the members or shareholders of the corporation. 4. Tenure of Ofiice a. Most corporations provide for the elec- tion of one or more new members to the board each year. b. Usually, the terms of office of members of the board are set at 1 to 4 years on a staggered basis to provide for greater continuity of function. 5. Board Functions a. The board provides overall direction of the corporation’s business. b. It establishes and administers corporate policy. 0. It determines the program of the corpo- ration and provides general direction and guidance in its execution. d. The board’s program directives are car— ried out by an administrative staff employed by the board. This staff is delegated responsibility for executing corporate functions. 13 B. Officers of the Corporation The primary function of the oflicers of the cor- poration is to provide for the general manage- ment of its affairs. 1. Met/90d of Selection Officers of the corporation are usually elected by the board of directors from its own member- ship. However, the bylaws may be written to provide for their direct election by the corpo— rate membership, if desired. 2. Duties, Functions, and Responsibilities The duties, functions, and responsibilities of the officers will generally be specified in the by— laws and are those normally assigned to the officers of an elected group. a. President The president is the chief executive of the corporation and serves as chairman of the board of directors. b. Vice President The vice president, in the absence of the president, performs the duties and exer- cises the powers of the president. The board of directors may also delegate to him other duties, authority and responsi- bilities. c. Secretary The secretary prepares and maintains min- utes, records and reports on all board meet- ings and actions. He is the custodian of the seal of the corporation and functions as the corporation’s official agent in certifying corporate instruments. (1. Treasurer The treasurer is the custodian of all the corporation’s resources, including its cash, records and titles of funds. He prepares and presents to the board special and periodic reports of the financial status of the corporation. C. Administrative Staff The duties, functions, responsibilities, and line of authority of the administrative staff are determined by the board of directors. These duties include the day-to-day operation of the corporation’s business of developing, merchan- dizing, servicing, and evaluating prepaid den- tal care contracts. Stafling plans should consider future growth and anticipated service requirements. Such plans should beigeared to provide increasing economy of operation through the fullest use of basic stafl' personnel. 1 . Executive Director The executive director is the chief administra— tive officer of the corporation. a. Responsibility and Authority The executive director is usually appointed annually by the board of directors and is responsible for the day-to-day operation of the corporation. He also is given the au- thority to employ the staff to operate the corporation. 14 b. Duties The duties of the executive director include, but are not limited to, these activities: (1) acts as the board’s agent in carry- ing out its decisions and opera— tional directives; (2) serves as an adviser to the board of directors; (3) employs, trains, and supervises the corporation’s staff; (4) develops and maintains effective records and communications sys- tems; (5) develops, assists in negotiating, and supervises the servicing of dental care contracts; (6) prepares the annual budget, and arranges for audits and financial analyses of the corporation’s books and financial records; (7) prepares reports, analyses, and operational proposals for board action. 2. Other Stafl As the corporation becomes operational and contracts are negotiated, additional personnel will be required. These might include: a. Clerks, secretaries, and typists. b. Claims supervisor. c. Director of sales and service. (1. Comptroller. e. Director of public relations and infor- mation. D. Consultant Services Besides the regular staff, the corporation will need special or technical services. While the volume of business may justify the employ- ment of some specialists on a full-time basis, the services of others may be purchased on a part-time, or consultant basis. Some of these specialists and their functions are: 1 . Legal Counsel Legal counsel plays an important role in the formation of the service corporation. His services continue to be required when service contracts are written, when changes or amend- ments to the bylaws are needed and when griev- ances of a legal nature are brought against the corporation. When forming the corporation, legal services may be retained as required. As the organization grows, legal counsel may be required as a semipermanent or even permanent member of the administrative staff. 2. Accounting Services The bookkeeping and accounting needs of serv- ice corporations will vary in type and volume. Whether the corporation maintains its own ac- counting records or contracts for such services is determined by the volume of fund accounting. Permanent bookkeeping and accounting person- nel may be added to the staff as the demand for service and contract volume increases. 3. Dental Director or Consultant Decisions of a professional nature are required in the servicing of dental care contracts. Den- tal consultant services may be purchased on a part-time basis when the volume of contracts and claims is small. As the volume of business in- creases a full-time dental director may be employed. 4. Actuarial Consultant Actuarial advice and assistance are necessary in the design of service contracts, developing cost estimates, and in fixing premium rates Such services may be purchased as needed when the corporation begins its operations. The growth of corporate activities may eventually justify the full-time employment of such specialized services. E. Advisory Committees To help reach the goals set for the corpora- tion, certain duties and functions may be dele— gated to committees. Selected by the board from the corporate membership, these commit- tees are responsible to it for their actions. Ex- amples of some of these committees and their functions are: 1. Dental Health Education Committee This committee advises the board of directors on the design and use of informational mate- rials to inform patients eligible for prepaid den- tal care of the availability of services and the value of regular dental care. 2. Quality Assurance Committee This committee develops and operates programs designed to assure the delivery of dental care of a high quality. 3. Contract Negotiating Committee The president of the corporation, its legal coun- sel, and the executive director frequently make up the standing committee responsible for the 15 planning and negotiation of service contracts. Their recommendations and actions are sub- ject to the approval of the board. 4. Finance Committee This committee, usually chaired by the treasurer of the corporation, helps the treasurer and ex- 16 ecutive director plan and manage the corpora- tion’s fiscal operations. 5. Executive Committee The officers of the corporation make up the ex- ecutive committee. It manages and directs cor— porate affairs between meetings of the board of directbrs. LI DENTAL SERVICE CORPORATION Organizational Chart State Dental “”6““ ———————————————————————— CORPORATE MEMBERS ________ _ Subscribers Membership Officers Dental Care & Liaison Trustees Committee \ \ \ \ \ \ \ \ \ BOARD OF DIRECTORS F' Quality Executive Contract Dental Health C mm}? Assurance Committee Negotiating Education °""'“ 99 Committee (Officers) Committee Committee Dental Legal Executive Accounting Actuarial Director Counsel Director Consultant Consultant Director . Director . Claims Clerical Comptroller of _ Supervisor of Sales Staff Information and Servrce V. Records and Reports Corporation planners must develop a good record system. Such a system is es- sential to the efficient management of the program and is necessary to satisfy contractual and legal obligations. A. Record Requirements Various types of data are needed for program operation, periodic review and evaluation. These data, and examples of records required for their collection, are: 1. Data for Program Operation a. Enrollment records. b. Examination and treatment records. 0. Cash receipt and payment recOrds. and patient eligibility 2. Data for Program Review and Control a. Subscriber utilization statements. b. Dentist records. 0. Screening reports and treatment records. d. Bookkeeping and accounting records. participation and payment 3. Data for Future Program Planning and Analysis a. Utilization records. b. Treatment frequency tabulations. 0. Financial audits. B. Record Systems Design Record systems must be designed to meet the requirements of the corporation. Some design considerations are: 1. Need for Flexibility Records should be kept flexible in number and type and in the method of their preparation and processing to meet the needs of the growing corporation. 2. Eflects of Size of Operation The data needed and the volume of records re- quired will depend on the number and size of contracts serviced and the number of employees available. 19 3. Metbod of Data Processing Until there is a large volume of claims (usually 5,000 a month), record maintenance and data processing can remain a hand operation. Rec- ord systems should be designed so that they may be readily converted to a machine operation when the volume of business warrants. 4. Adequacy Records systems should be designed to meet both the immediate and future needs of the corpora- tion. Adequate design will help limit the num- ber of records required and the frequency of revision and reprinting. C. Record Prototypes Some of the records and reports needed in op- erating a dental service corporation, with a brief description of each, follow: 1. Enrollment Card This card provides a record of the persons en— rolled for care under a prepaid dental care plan. It also serves as an authorization for release of treatment information. The enrollment card should provide for: a. Name, age, address, and date of birth of subscriber. b. Group number, subscriber membership number, effective date of membership. 0. Name, date of birth, sex, and member— ship number of enrolled subscriber de- pendents. (Some service corporations now use social security numbers for membership identification.) d. Signature of subscriber to a statement that authorizes disclosure of confidential treatment information to the service corporation. 2. Eligibility Record This is an alphabetic listing or simple file card record of subscribers and their dependents who are eligible for care. It should contain their names, their group and membership numbers. This record is modified at specific intervals to reflect additions and deletions to the list of eligible enrollees as reported by the contracting group. It may be used as a cross reference in identifying eligible enrollees. 3. Record of Subscriber Membership Numbers This record is a numerical listing of all eligible subscribers and their dependents. It is also 20 used as a cross reference in identifying eligible enrollees. The form should provide for: a. Name of member, family and individual numbers. b. Name of each dependent, family num- ber and their individual numbers. 4. Dental Program Membersbip Statement This form is used by the contracting group to report to the service corporation any changes in subscriber membership enrollment and eligi- bility. New enrollments and terminations of eligibility should be reported on a periodic basis, usually each month. The form should provide for: a. Name of contracting group. b. List of newly enrolled subscribers and their dependents, if covered. (An indi- vidual enrollment card should be sub- mitted with each new name added to the eligibility list.) 0. List of terminated subscribers and their dependents. This list should include the subscriber’s name, date of birth, group and membership number for proper identification. 5. Patient Ledger Card This card is used by the service corporation as a permanent record of services received by enrollees. The form should provide for: a. Identification of subscriber member. b. Recording of treatment service data—to include: (1) Dates of service. (2) Types of service. (3) Amount of charges and credits. 0. Other treatment and financial data needed for future program evaluation and analysis. 6. Examination and Treatment Voucher Form This multiple copy form serves three basic functions: a. provides the participating dentist with a convenient method of reporting his diagnostic findings and plan of treat- ment; b. serves as a statement of services ren— dered by the dentist in billing the service corporation for payment; 0. serves as the primary source of utiliza- tion, treatment and cost data for pro- gram analysis, and review. The form should provide for: (1) Identification of the patient: (a) Subscriber membership and group member. (b) Statement of eligibility status. (2) Description of dental needs of pa- tient and plan of treatment: (a) Description of individual den- tal services. (b) Procedure code numbers. (c) Dates service began and date of completion. ((1) Charge for each service. (e) Identification of tooth and the surfaces involved. (3) Statement of total charges for services rendered and an identifi- cation of costs to patient and serv- ice corporation. (4) Certification by patient and/or dentist attesting to the completion of the treatment plan. Design of any examination and treatment voucher should include a system of coding to identify individual dental procedures. With such a system the voucher can then serve in billing and also as a source of treatment data. 7. List of Participating Dentists This is a record of dentists, listed alphabeti- cally, who have contracted to participate in the programs of the service corporation. The form provides for the names of the dentists, their ad- dresses, and the corporation identification num- bers assigned to them. 8. Form for Incomplete and/ or Incorrectly Executed Treatment Vouchers This is a memo form that provides the service corporation with a convenient method of noti- fying dentists of errors or omissions on sub- mitted treatment vouchers. The form provides for: a. Examination and treatment voucher number. b. Patient identification. 0. Check list of voucher deficiencies, such as: ( 1) Incomplete service information. (2) Signature omitted. (3) Inadequate identifying informa— tion. 9. Service Review Form This is a form used by the corporation in its service review and quality assurance program to report on the adequacy and completeness of the services provided. The form provides for: a. Patient’s name and identifying informa— tion. b. List of dental services performed. . Date dental service performed. 01. Screening dentist’s statement of find- ings. e. Signature of screening dentist or review— ing officer. 0 10. Specialty Services Referral Form This form is used to request treatment from a specialist for a subscriber when his private den- tist recommends specialty care to complete the course of treatment. The participating dentist initiates and forwards the form to the specialist. The specialist uses the form to certify that serv- ices have been completed. He then returns it to the corporation for payment for his services. The form provides for: a. Patient identification. b. Date of referral. 0. Name of referring dentist. 21 (1. Nature of specialty services required. e. Signature of dental specialist covering statement of work completed. 11. Eligibility Verification Postal Card The participating dentist sends this card to the service corporation for vertification of patient’s eligibility under the program. The form provides for: a. Patient’s name, age, and address. b. Name of patient’s dental program. . c. Name of dentist requesting verification, address, date, and phone number. 12. Dental Program Utilization Statement This is a periodic statement of charges made by the dental service corporation against the con- sumer group account. The statement provides for: a. Identification of period of report. b. Group name and address. c. Fiscal information: (1) Summary of charges. (2) Funds on deposit for regular care. (3) Funds on deposit for emergency care. (4) Administrative charges. d. List of individuals reporting for dental care for the first time in contract year or for emergency care. 13. Monthly Statement of Amounts Voncbered A statement used by the service corporation to inform the consumer group of the total charges vouchered by dentist-s for services each month. The statement provides for: a. Identification of reporting period. b. Group name and address. 22 c. Fiscal information: (1) Amount vouchered for regular care. (2) Amount vouchered for emergency care. (3) Total. 14. Form for Nonantborized Treatment A form used by the dental service corporation to inform dentists why a particular service was not authorized or payment not approved. The form provides for: a. Identification of the treatment voucher in question. b. Patient identification. 0. Reasons for nonauthorization or disal- lowance may be presented in convenient checklist form: (1) Service not covered in contract. (2) Exception to proposed plan of treatment. (3) Inadequate identification or proof of need for service proposed. 15. Participating Dentist Index Card The service corporation uses this card as a per— manent record of participating dentists, their location, and identification number. The card provides for: a. Dentist’s name, address, office phone. b. Dentist’s identification number. 0. Dentist’s specialty. 01. Original date of participation in pro- gram. e. Date of termination of participation. f. Space for remarks. Some service corporations use subscriber iden- tification cards as an aid in establishing patient eligibility. However, it is difficult to keep such cards current because of frequent changes in eligibility. VI. Operations The major function of the service corporation is to negotiate and service contracts for dental services. In addition, a number of related operations are conducted. The followingis an outline of some of these operations with suggested methods for conducting them. A. Cost Estimating “Ratemaking” or developing cost estimates is an actuarial operation. In establishing pre— mium rates, available claims and utilization ex- perience data are analyzed. Premium rates or cost estimates should cover anticipated claims and operating expenses. They should also be reasonable, but not excessive, and should apply equitably to all risk groups. They should be as stable as current cost will permit while retain- ing flexibility to permit change with experience. Finally, rates should be uniform and designed to prevent financial loss. Health needs in general and dental needs in par- ticular do not readily lend themselves to classic insurance principles. Although there are some fairly well defined guidelines that can be fol- lowed, there are no fixed methods for making cost estimates or fixing premiums. Some of the basic underwriting considerations in ratemaking are: 1. The Size of the Group To Be Covered The degree to which risks may be spread and reasonably predicted will be affected by the number of persons covered in an insured group. Large groups provide a broader base for the spread of risks than small groups. 2. The Demographic Characteristics of the Insured Group An analysis of the age-sex distribution, average family size and socioeconomic status will give some measure of the dental needs of a group as well as the anticipated rate utilization of dental . services. 3. The Group Attrition Rate or Rate of Turnover The more stable a group, the more predictable will be their dental needs and demands for serv— ice. A high rate of turnover within a group will affect the patterns of dental need and serv- ices required since new members will introduce undetermined quantities of accumulated dental needs. 4. The Anticipated Rate of Utilization of Dental Services Accurate estimates of the group utilization rate are probably the most difficult underwriting 23 considerations in ratemaking. Until a service corporation gains enough experience from its operations to include utilization rates as “built— in” elements in the ratemaking process, it must estimate utilization on the basis of the group’s characteristics. 5. The Scope of Benefits Covered The scope of dental benefits provided under a prepayment plan will effect the cost of the plan. The more comprehensive the benefits, the higher the premium cost will be. As experience is gained, benefits can be added on a scheduled basis. 6. Benefit Limitations Limiting factors such as deductibles and co- insurance will greatly affect the cost of a plan. These factors, in addition to limiting the claims liability of a service corporation, discourage or reduce utilization rates. Although these factors permit wider service benefits for groups with limited resources, their use should be restricted if maximum utilization is to be encouraged. 7. The Type of Benefit In ratemaking, the premium determination is affected by the type of benefit payment em- ployed. Benefits may be classified according to the method used to defray the cost of dental service. These tw0 classifications are referred to as “service benefits” and “indemnity benefits.” a. Service benefits provide for direct pay— ments by the service corporation to the dentist. b. Indemnity benefits provide for the pay- ment of cash allowances or reimburse— ments by the insurer to either the insured or his dentist. Under the former, complete coverage of cost is implied; in the latter, less than full coverage is expected. 8. The Schedule of Fees, Table of Allow- ance, or Other Schedule of Benefit Rates Paid Obviously, the cost of a plan will vary accord— ing to the rates paid for individual items of den- tal service. 9. The Method of Premium Determination Used A final consideration in underwriting is the method of premium determination used. Two basic methods employed are known as “com— munity rating” and “experience rating.” a. In community rating, costs of care are averaged for all contracting groups into a single rate. All losses (or claims) are thus spread evenly among the total in- sured group populations. b. In experience rating, premium cost is fixed according to the incurred claims ex- perience of the particular group for which the rate is being developed. A group with high claims experience thus pays a proportionately higher premium than a group with lower claims experience. B. Contract Negotiating The form and content of service contracts has already been discussed in section III, B4; thus the following comments are limited to the meth— ods of contract negotiations. 1. Designation of Negotiators Experience has shown that a contract is devel- oped more through discussion than negotiation or bargaining. Since these discussions may in- volve many considerations that require profes- sional decisions, as well as legal and administra- tive details, it has been found that a small team 24 of negotiators made up of a dentist, an admin— istrative officer, and legal counsel works quite well. This team is appointed by the corpora- tion’s governing body. The dentist appointed should probably be the president of the service corporation or a dentist member of the governing board appointed by him. The executive director, or chief admin- istrative officer of the corporation, as well as the corporation’s counsel, are usually members of the team. 2. Need for Flexibility The negotiating team should strive for flex- ibility in its discussions. The team should pre— sent well-prepared proposals together with spe- cific alternative plans and suggestions at planning or negotiating sessions. The regulations and operating policies of con- sumer groups often prevent acceptance of the initial proposal. Service corporation negotia- tors must therefore be prepared to modify a con— tract proposal to meet the needs, conditions, and desires of the contracting group. Some corporations have found that a single ne- gotiating representative is not only adequate but also increases flexibility. Still others have employed brokerage services to manage contract negotiations. This relieves the corporation of much of the burden and de- tail of contract acquisition. However, the cost of such brokerage services, together with the implied loss of control of the negotiations, should be carefully weighed against the cost to the corporation of performing the same services. 3. Negotiable Items In presenting a contract proposal to a potential consumer group, early resolution of the follow- ing items should be sought: a. What age limitations are to be imposed on enrollment eligibility? b. What is the level of dental coverage de- sired? Is the level compatible with available funds or the price the group is prepared to pay? c. What alternative plans, benefit exclu- sions, or contract limitations might be imposed to provide the most comprehen- sive and desirable coverage possible within the limits of the consumer’s resources? d. What administrative services will the consumer group require? What cost al- lowance or retention rates will be charged by the service corporation for these and other administrative services? e. What procedure is to be used to evaluate the quality of care? f. What method of premium payment is to be used? 4. Premium Payment Methods Premium charges are commonly assessed by either the capitation or the utilization methods. a. Capitation In this method the premium is expressed in terms of the cost per person eligible for care under a contract. Since the cost of providing care is spread throughout the eligible group population, this method of assessment results in lower individual pre— mium costs. The group assumes the pri- mary responsibility for the extent of utili- zation and the corporation assumes the risk. This method also provides the service corporation with specific estimates of its premium income. Thus more effective administration and budget planning is possible. b. Utilization Under this method, the premium is ex— pressed in terms of the cost per person ac- tually using the dental services available under the contract. This method usually results in higher and less accurate individ— ual premium costs. Although the corpora— tion has the primary responsibility under this method for the extent of utilization, close budgetary control is necessary because of the uncertainty of the rate of utilization. In practice, the consumer group assumes the risk in such cases. Contracts using this method of payment are generally of the open-end, nonrisk, or cost—plus type. 5. Contract Commitment: and Elasticity a. Open-end Contracts Open—end contracts provide for the adjust- ment of service benefits according to claims experience and, in effect, limit benefits to available premium income. Unused pre- mium income is returnable to the contract- ing group either in cash, advance credits on contract costs, or expanded benefits. On the other hand, inadequate premium in- come can result in the reduction or termina- tion of benefits. In such cases benefits are continued only upon payment of additional premiums by the consumer group. b. Closed Contracts Closed, or risk type, contracts permit little 25 or no departure from the service commit- ments of the corporation except as specifi- cally provided for in the contract. When the aggregate premium income is insuf— ficient to meet claims costs, such contracts also provide that any resulting losses must be borne by the corporation. These losses may be absorbed either by drawing on re- serve funds created for this purpose or through prorated claim payments. At the same time, any uncommited premium in- come may be deposited in the reserve ac- count to replace losses on other contracts. It also helps to insure against possible fu— ture losses. C. Contract Servicing Some of the operations required to service con- tracts are: 1. Establishment and Maintenance of Eli- gibility Rolls This is a procedure to identify eligible enrollees in a program. It provides for the daily review and revision of the rolls to reflect additions, de- letions, and other enrollment changes. It also provides the information needed to assure that authorizations for dental care and the payment of claims are limited to those who meet the eligibility and enrollment requirements of the plan. 2. Treatment Autborization Many service corporations require the pre- authorization of treatment plans that involve dental care in excess of a fixed dollar value. Such authorization is granted by the corpora- tion’s dental director before the performance of the service and is sometimes referred to as a “prestatement of costs.” Preauthorization per- mits the service corporation to keep a close ac— countng of its financial commitments, to verify the patient’s eligibility for care, and to assure that the services proposed are covered under the contract. 3 . C laims Payment The processing of treatment vouchers, or claims for payment received from dentists for com- pleted treatment, is one of the most important daily operations. As mentioned before, ex- perience has shown that until the volume of claims reaches a sizable level (about 5,000 claims per month), the processing of claims for pay- ment can remain a hand operation. Every ef- fort should be made to assure that all claims are processed and paid promptly to contribute to both patient and professional satisfaction. 4. Quality Assurance Consumer groups which enter into contracts with service corporations expect to purchase dental services of high quality. To assure that the dental services provided meet high stand- ards, service corporations have developed meth- ods for review of completed services. In most of these procedures, a professional evaluation is made of the dental care provided to a repre- sentative group of patients. The evaluation of dental care should give consideration‘to both consumer and professional interests. 5. Program Analysis and Financial Review A regular review should be made of the financial condition of the corporation and each of its con- tracts. Such reviews should provide for the periodic analysis of claims, utilization, and op— erational experience as documented in the rec- ords and reports maintained by the corporation. D. Developing and Maintaining Communications The success of a dental service corporation’s operations will greatly depend on the early de- velopment of an adequate system of communica- tions. Since the corporation serves both the 26 profession and groups of consumers, it is essen- tial that communications be maintained with both groups. In fulfilling its role of making more dental care available to more people, the service corporation should also establish good communications with the general public through the press and other mass media. Some of the methods that may be used in devel- oping an effective system of communication with these three groups are: 1. Communications With the Profession Through: a. professional publications and corre— spondence; b. workshops, district conferences2 and lo- cal society meetings; 0. personal contact and conversation; d. free liaison with the State dental associ- tion and service corporation officers and management. 763—660 0—65——4 2. Communications With Consumer Groups Through: a. planned programs of dental health edu- cation ; b. well designed brochures to explain pro- gram benefits and procedures; 0. efiicient handlings of claims and business relationships. 3. Communications With the Public Through: a. periodic press releases on plan availabil- ity and desirability ; b. well timed press releases and announce- ments of corporate activities and opera— tions; 0. personal contact with potential consumer groups. 27 ... firm w'.‘>w‘3‘,7 APPENDIX A Principles for Determining the Acceptability of Plans for the Group Purchase of Dental Care Following is the statement “Principles for De- termining the Acceptability of Plans for the Group Purchase of Dental Care” as adopted by the House of Delegates of the American Dental Association (trans. 1953 :226, 1955 :215, 1956: 203, 1957 :389, 1958 :410, 1959 :231) : 1. The plan should be developed, main- tained, and promoted to the public with the advice of authorized representatives of the local and State dental societies. . The plan should encourage the main- tenance of a high standard of dental treatment. . If the plan provides direct service bene- fits, it should be operated on a not-for- profit basis. .The promotional standards under which the prepayment plan is devel- oped must meet the requirements of the “Principles of Ethics” of the American Dental Association and the codes of ethics of the State and local dental so— cieties involved. . The limitations of benefits available under the plan must be clearly described. . The areas of responsibility involved in administration of the plan must be rec- ognized and properly evaluated: a. The basic policies and operation of the plan should be eflicient and eco— nomical and should provide freedom to experiment with methods of pay- ment by beneficiaries. b. The administration of the profes- sional phases of the plan should be entirely within the control of pro— fessional personnel. Professional standards and treatment should not be controlled by nondental admin— istrators. c. The method of authorization of den- tal care under a prepayment plan should prevent any interference with the dentist-patient relationship or the professional judgment and deci‘ sion of the dentist. 7. The determination of costs of dental care should be based upon accurate, cur— rent statistical data which reflect fees in the area in which the plan operates. Fee schedules and tables of allowances should be developed with the advice and assistance of the dental society in order that they may (1) make possible high standards of treatment in providing benefits under the plan, (2) be adjusted in accordance with changes in the eco— nomic level at reasonable intervals. 29 30 8. The patient must have freedom to choose, Within the agreed limitations of the plan, the dentist to Whom he may Wish to apply for treatment. Similarly, the dentist, Within the same limitations, must have the right to accept patients who apply for treatment. . The financial reserves of the plan should be adequate to assure continuity of the program. 10. All ethical, qualified dentists must be 11. 12. 13. eligible to participate Within the agreed limitations of the plan. The plan should make adequate provi— sions for the adjustment of any com- plaints that may arise in the dentist- patient relationship. The plan should provide for the maxi‘ mum use of existing facilities. The plan should include a sound pro- gram of dental health education for its beneficiaries. APPENDIX B Status of Dental Service Corporations and Related Planning in the United States, July 1, 1964 Dental Service Corporations in Operation: (9) California Hawaii New York Colorado Michigan Ohio Connecticut Dental Service Corporations Established; No Contracts: (13) Arkansas Mississippi Oklahoma Georgia Missouri Pennsylvania Kentucky Nebraska Rhode Island Maryland Enabling Legislation Enacted; N o Corporation Reported: (9) Massachusetts New Mexico North Dakota Minnesota North Carolina Tennessee New Hampshire Plan to Introduce Required Legislation: (4) District of Columbia Illinois Maine Oregon Washington South Dakota West Virginia Wisconsin Texas Virginia New Jersey 31 Preliminary Studies and/ or Planning of Prepaid Dental Care Programs: (13) Alabama Indiana Louisiana* Arizona* Iowa ' Montana Delaware* Kansas* Nevada* Florida* No Activity in Dental Prepayment Reported: (4) Alaska Idaho Puerto Rico* *Enabling legislation required. 32 South Carolina* Utah Vermont* Wyoming APPENDIX C Existing Dental Service Corporations July.L 1964 Established under— Name of corporation Year in- corporated Enabling Existing In opera- legislation statutes tion Arkansas Dental Service Corp- _ _ - ______________ 1959 __________ X __________ California Dental Service ______________________ 1955 __________ X X Colorado Dental Service, Inc ___________________ 1958 __________ X X Connecticut State Dental Service, Inc ___________ 1962 __________ X Georgia Dental Service Corp ___________________ 1962 __________ X __________ Hawaii Dental Service _________________________ 1962 X __________ X Kentucky Dental Service Corp _________________ 1963 X ____________________ Maryland Dental Service Corp _________________ 1964 __________ X __________ Michigan Dental Service Corp __________________ 1957 __________ X X Mississippi Dental Association Service ___________ 1962 X ____________________ Missouri Dental Service, Inc ___________________ 1958 __________ X __________ The Nebraska Dental Service ___________________ 1962 __________ X __________ New York Dental Service Corp _________________ 1960 X __________ X Ohio State Dental Care Corp ___________________ 1960 X __________ X Dental Health Corp. of Oklahoma _______________ 1962 __________ X __________ Oregon Dental Health Foundation ______________ 1955 __________ X X Pennsylvania Dental Health Association _________ 1962 __________ X __________ Rhode Island State Dental Service Corp _________ 1959 X ____________________ South Dakota Dental Service Corp ______________ 1963 X ____________________ Washington Dental Service _____________________ 1954 __________ X X West Virginia Dental Service Corp ______________ 1962 X ____________________ Wisconsin Dental Service Corp _________________ 1962 X ____________________ APPENDIX D Selected Examples of Dental Service Corporation Records and Reports Page 1. Enrollment card ______________________________________________________________ 36—38 2. Record of subscriber membership numbers ___________________________________ I- __ _ 39 3. Dental program membership statement __________________________________________ 4O 4. Patient ledger card ____________________________________________________________ 41—42 5. Examination and treatment voucher form ________________________________________ 43—46 6. Participating dentist list _______________________________________________________ 47 7. Treatment voucher correction form ______________________________________________ 48—50 8. Service review form ___________________________________________________________ 51—55 9. Specialty services referral form _________________________________________________ 56 10. Eligibility verification postal card _______________________________________________ 57 11. Dental program utilization statement ____________________________________________ 58 12. Monthly statement of amounts vouchered ________________________________________ 59 13. Form for nonauthorized treatment ______________________________________________ 60 14. Participating dentist index card _________________________________________________ 61 35 Enrollment Card NEW YORK DENTAL SERVICE CORPORATION ENROLLMENT CARD F°R,:°"°' PM I ALI. INFQRMATION LAST NAME FIRST NAME INITIAL DSC USE ONLY GROUP NO. HOME ADDRESS CITY ZONE STATE SUB NO. MALE El SINGLE CI WIDOWED. DIVORCED soclAL sEcuRn-Y No. TYPE OF OR LEGALLY COVERAGE FEMALE El MARRIED D SEPARATED D DATE «0. DA. YR. OCCUPATION DATE OF MO. DA. YR. EMPLOYED BIRTH RATE EFF. NAME OF FIRM DATE / / NAME OF HUSBAND El MO. DAY YR. SPOUSE WIFE [I DATE OF BIRTH LIST ALL UNMARRIED CHILDREN UNDER 19 YEARS IN ORDER OF AGE (OLDEST FIRST) FIRST NAME INITIAL I SON DAUGHTER | BIRTH DATE l MO. DAY YR. ' I 1 l E] D I I I 2 | D D l 3 I [II D l 4 I [I D I I I 5 y [I [I I s I E! D I ' I 7 I [:1 [3 PLEASE COMPLETE REVERSE SIDE Face Return This Card To Your Employer or Other Remitting Agent I hereby apply for myself. and as applicanf for members of my family. if any. lis‘led hereon for Denial Service Corp. Conlracf _____________ a? a monlhly tale of $_.____ for each adult (applicanl and spouse) and $__.____ for each child six years of age fhrough eigh’raen years of age. {No charge for children under six years of age). I agree Io pay in advance Ihe charges {or Ihe conlracf applied for. unless my employer pays all of ihe charges for said confracf. l direcl’ my employer. as remifling agen'r. Io deducf such charges from my salary or wages and lo remiI {hem Io ihe Denral Service Corporation. All information furnished by me in fhis applicaiion is Irue and complefe. IIGNATUIE OF IPPLICANT Back Enrollment Card l Group Number Membership Number Effective Date l No. Persons (Above For Office Use Only) Subscriber’s Full Name (Print) Last First Middle Home Telephone Address Number No. and Street City Zone Date of I] Male Marital El Single [I Widowed Birth—fifi B Female Status I] Married I] Divorced Organization Name Registration Number I hereby enroll in the dental service plan. My dependents are listed on the reverse side. benefits and payments will be in accordance with the group contract agreement. close to the Michigan Dental Service Corporation and to the I understand that coverage, I hereby authorize my dentist to dis- \ any information necessary for dental treatment authorization and such other purposes as are necessary for'the administration of the agreement. Signature of Subscriber FORM A—EN ROLLMENT CARD Face Date MICHIGAN DENTAL SERVICE CORPORATION DEPENDENTS OF SUBSCRIBER Date of Birth Middle Month Membership umber Assigned Sex Year Male Female Back (Below For Office Use Only) DEDUCTIBLE SATISFIED Membership No. Year Amount Membership No. 37 89 Continuous lrilerfolded ® MBF e O TEAR ALONG THESE PERFORATIONS O Enrollment Card FOLD ALONG THIS PERFORATION D r washmqton Cental SGRVICG A WASHINGTON NON-PROFIT HEALTH CARE SERVICE CONTRACTOR 416 GROSVENOR HOUSE, SEATTLE 1, WASHINGTON This certifies that the subscriber shown below has been enrolled under the indicated program. Benefits, contract limitations, and exclusions are set forth in the service agreement covering each member. MAin 2-2283 SUBSCRIBER NUMBER EROGRAM: l . YR. ELIGIBILITY EXPIRES ’J FOLD LINE HERE IS YOUR WASHINGTON DENTAL SERVICE SUBSCRIBER SERVICES CARD FOR YOUR CON- VENIENCE, PLEASE DESTROY ANY CARD PREVIOUSLY ISSUED. . DETACH ALONG PERFORATION, FOLD, AND KEEP THIS CARD WITH YOU FOR PRESENTATION TO YOUR DENTIST. . YOUR PARTICIPATING DENTIST WILL HAVE A LIST OF THE BENEFITS OF YOUR PROGRAM. THE CARD IS NOT TRANSFER- ABLE AND WILL BE VALID ONLY FOR THE PERIOD INDICATED. ®e Record of Subscriber Membership Numbers MICHIGAN DENTAL SERVICE CORPORATION DENTAL SERVICE PLAN MEMBERSHIP NUMBERS ASSIGNEQ Group Group Number Identification: Name Assigned Membership Number Family Individual Name of Member Number Number FORMAa MD 50 Name of Group Dental Program Membership Statement Michigan Dental Service Cemoretion_ 430 STODDARD BUILDING, lANSING 13, MICHIGAN TELEPHONE IVANHOE 5-7I04 DENTAL PROGRAM MEMBERSHIP STATEMENT Address Change in Enrollment Since Last Regort: Members Added (Enrollment Card Enclosed) Regis- Number of tration Persons Name of Subscriber Nos Enrolled Eligibility Terminated Subscriber's Birth Registration Name of Member Date No. Date By Title FORM E '40 Patient Ledger Card DENTIST NUMBER NAME CODE GROUP MEMBERSHIP EFFECTIVE N0. DATE ENIOL. FAM. INDIVI OF BIRTH PAYMENT TO D.D.S. BY MID.S.C‘ 0311OHN3 um I D": u" TYPES or SERVICES mg“ 5,11,26,15? SERVICE DATE CHECK no. AMOUNT GROUP NUMBER DENTAL SERVICE CORPORATION - LANSING, MICH. PATIENT LEDGER CARD (roam AB) ROYAL MEIR DETIDIY JD 31."! Face EXAMINATION AND TREATMENT VOUCHER SENT To MEMBER 0R DENTIST: DATE BY DATE av DATE av DATE DATE OF LAST PREVIOUS DENTAL CARE PRIOR TO INITIAL CARE UNDER PROGRAM PAYMENT To I105. BV M.D.S.C. ”m u" VOUCHER SERVICE TYPES or SERVICES m $11,213:? DATE cchx no. AMOUNT Back 41 Patient Ledger Card SPECIAL PROCD. DENTIST SPECIAL PROCD. DENTIST Face SPECIAL PROCD. DENTIST SPECIAL PROCD. DENTIST III L55I22 Back 42 Examination and Treatment Voucher Form (3.0.5. USE ONLY mama CALIFORNIA DENTAL SERVICE Posr omc: m use . RIIIcou AIIIIEx - SAII ERAIICIsco, CALIEouIIA 94m GROUP NO—fi— _ [I sum: I-aau , EMPLOYEE’S UNION EMPLOYEE soc. SEC. NO. LOCAL NO. RELATIONSHIP PATIENT'S PATIENT To EMPLOYEE BIRTH DATE PATIENT HAS PATIENT HAD PREVIOUS ADDRESS DENTAL CARE UNDER THIS PROGRAM? I:I YES I:I "0 NAME OF NAME OF GROUP EMPLOYER DENTAL PLAN STATE DENflST's LICENSE NAME DATE NUMBER Is PATIENT COVERED FOR DENTAL CARE BY STREET ANOTHER PLAN? I:I YES I:I N° CITY I. STATE PHONE IF YES, NAME OF PLAN \ EXAMINATION AND TREATMENT RECORD I 0 o D Q? LIST IN ORDER FROM TOOTH No. I THRU TOOTH No. 32 x-RAYs ENCLOSED I:I YES E] N° 0 RE- "5- DATE c.n.s. "0‘ "Hun” CEnIIEE SERVICE IEIVICE FEE Us: I 7 I ' ID DI "'OLVED ATIVE NUIIEI DNL‘I é fl SE, % @fi'fi “- flfifig I“? DEEIDUOUD Elfin W?“ ESE FEED: #2 Page “and “ 00 I WIN $3 6? Q0 6 FOR CDS USE ONLY I HEREBY ACCEPT THE FOREGOING TREATMENT PLAN AND HERE- 10”“ FEE BY AGREE TO ALL THE TERMS AND CONDITIONS SET FORTH IN THE APPLICABLE CD5 GROUP CARE CONTRACT. PATIENT PAYS BALANCE I HEREBY CERTIFY THAT THE APPROVED SERVICES LISTED ABOVE HAVTE BEEN PERFORMED IN ACCORDANCE WITH THE PROVISIONS S GROUP RE CONTRACT TO WHICH I HEREBY AGREE AND PAYMENT IS THEREFORE DUE AND PAYABLE % C.D.SI PAYS 9 DBITIST SIGNATURE 43 Examination and Treatment Voucher Form THE NEW YORK DENTAL SERVICE CORPORATION Thirty East Forty — Second Street YUkon 6 - 6430 FOR New York 17, New York MNO.2 INSTRUCTION TO DENTIST: This form No. 2 will be used to bill for services completed after Form No. I has been submitted. It is to be used only Ior billing in a continuous series of treatments for a patient. If the completed case was billed on Form No, I, keep this form in file for future use. DENTIST WILL FILL OUT SECTION BELOW (TYPE OR USE BALLF‘OINT PEN) CONTRACT NO. PATIENT'S NAME SUBSCRIBER NO. SUBSCRIBER’S NAME AGE MALE CI FEMALE [3 STREET RELAT ONSH P I I TO SUBSCRIBER SELF E] SPOUSE 1:] CHILD [3 CITY ZoNE STATE FOR D.S.C. USE ONLY L: ‘ 5 C.l. =Central Incisor IB.:First Bicuspid 2M.=Secand Molar a A \° b+L.l.=Laterallncisor 23.:5econd Biscuspid 3M.=Third Molar , 0 .1; §§ ‘ $0; C.=Cuspid 'lM.=First Molar DSIE DEgglESTS CAOMfEURNg-D CHASGE .3527 If .5 35 3‘ '45.? DENTAL SERVICES RENDERED SERVICE INSUEXNCE PATIENT Q o" T E 4' V 0 ENTER NUMBER AND DESCRIPTION OF SERVICES I/ 1/ 1/ I/ AS LISTED ON FEE SCHEDULE 5 S S FOR USE OF D.S.C. ONLY TOTAL TOTAL BILLING $ FOR DENTIST SERVICE BENEFITS s PRINT NAME DATE 5UBMITTED INDEMNITY BENEFITS COVERED BY D.S.C. CHARGE TO PATIENT AMOUNT (IF ANY) NOT ALLOWED PAID BY CHECK NO. IMPORTANT TO DENTIST 44 Return 2 copies at this form Billings submitted more 'l'10n 60 pating Dentist‘s Agreement). STREET TELEPHONE NO. CITY ZONE STAT E SIGNATURE OF DENTIST (white and pink) to Dental Service Corp. Keep blue copy in your file. days after patient is discharged will be discounted. (See Partici - S? N? 01099 MD MICHIGAN DENTAL SERVICE CORPORATION EXAMINATION AND TREATMENT VOUCHER SC 430 Stoddard Building. Lansing 23, Michigan Telephone IVanhoe 5-7104 I. Date Prepared... ....................................... Valid Until .............................................. [:1 Regular Care 1:] Emergency Care Only 11. Patient Name :.. Address Birth [I Male Parent or Guardian Telephone No. Date ........................................ 1] Female MDSC Group and Membership No. ........................ Registration No. with Contracting Group... III. Program Has patient had previous dental care under Date of last previous care from any source: this program: [I Yes [:1 No IV. The above person reported to me today for treatment and I have accepted him/her as a patient. I hereby agree to abide by the terms of the contract on file in the oflice of the Michigan Dental Service Corporation. Doctor’s Name........ Address Date V- TOOTH NUMBER 0R LETTER lsaegin Emanuel: and list in orider in SURFACES MATERIALS 1 2 3 4 5 o 7 8 9 10 11 12 13 14 15 16 UL ecfion 8 services require = . M—Meslal A—Amalgam Permanent PERMANENT TEETH, from Tooth 1).ka S—Silicate LR 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 LL IVE—*0. I through Tooth No. 32: O—Qcclusal R—Resin UR A B c D E F G n I J UL DECIDUOUS TEETH, from Tooth fifigfilfl Gaga?” D -.. No. A through Tooth No. T: 3—]; al ro LR T s R Q p o M N L K LL “°° VI. INSTRUCTIONS TO THE DENTIST (Use a typewriter or ball—point pen) 1. Complete form through “SERVICE”, Section VII at time of examination. Check Regular or Emergency Care in upper right hand corner and enter date of last previous dental care in Item III. Record estimated fee in Section VII. “CHARGE” Column. Forward COPY 4 and 5 to MDSC immediately. 2. Radiographs must be submitted with Copies 4 and 5 for patients requiring service in excess of $50.00, and additional service may NOT be performed without authorization. 3. Forward completed Copies 1, 2, and 3 to MDSC within 5_days of completion of treatment. Retain COPY 4 for your file. 4. EMERGENCY CARE ONLY: Initiate and complete the form through Section VIII. Name and Registration No. of the program subscriber is essential. Forward Copies 1, 2, 3, and 5 to MDSC within 5 days of completion of treatment. VII. Use one line for each operation or restoration. Service Service Tooth Date Charge MDSC Tooth Date Charge MDSC Entry Number Surfaces Restorative Proced— Service (See use Entry Number Surfaces Restorative Proced- Service See nae N n. or Involved Material are Performed Fee only No. or Involved Material are Perfumed ee only Letter C13? Description Schedule) Letter Clg‘c’le Description Schedule) 1. ll. 2. 12. 3. 13. 4. 14. s. 15. o. lo. 'I. 17. a. 18. a. 19. lo. 20. VIII. I hereby certify that the authorized services described above have been rendered and payment therefor is TOTAL CHARGE—ALL SERVICES _ _ s ______________________________ due and payable' Deductible _ $.................. When Doctor’s Signature Date Applicable """"" % Co-Payment """"""""" Less Total Charge to Patient - ............................. TotalChargetoProgram - - - - - Less Research and Development - - - FORM B—COPY-l MDSC Payment 111.10g Joqono A mammal pun uopcurumxg Examination and Treatment Voucher Form C] Initial E] Recall E] Emergency WASHINGTON DENTAL SERVICE " ROOM “6, 500 WALL STREET, SEATTLE I EXAMINATION AND TREATMENT PLAN FORM Phone MA 2-1914 Program LABIAL PATIENT M...- “was“ PARENT LOCAL MALE E] or AGE___ FEMALE I] GUARDIAN NO ELIGIBILITY CEASES ON I5th BIRTHDAY. I HEREBY CERTIFY THAT I HAVE MADE THE REQUIRED CLINICAL AND RADIOGRAPHIC EXAMINATION FOR THIS PATIENT AND RECOMMEND THAT THE SERVICES lISTED BELOW BE COMPLETED. {‘— PERMANENT—fl DENTIST'S DATE SIGNATURE lABlAL ADDRESS CITY PHONE ‘ INSTRUCTIONS TO THE DENTIST I. Dentist must be a WDS Partizipating Dentin. 5, Tooth chart must be completed. 2. Fill farm in Iully at time of examination. ‘ 6. Form must be submitted Ior payment within 30 days following comple- 3. Treatment exceeding 3 can NOT be performed without authorization. 7. 4. X-rays will be submitted only on request. tion of treatment. Penalty tor late billing. Sign form on bottom when treatment is complete. 8. Retain yellow copy for your file, Return white and blue copies to WDS. TOOTH NO. OR LETTER NO. OF SURFACES RESTORATIVE MATERIAL SERVICE IF SERVICES EXCLUDED BY THE PROGRAM ARE NEEDED, PLEASE INDICATE ON BACK USE ONE lINE FOR EACH OPERATION OR RESTORATION FEE (SEE WDS SCHEDULE) DATE TREATMENT PERFORMED MONTH DAY (-5 TOTAL I HEREBY CERTIFY THAT THE APPROVED SERVICES DESCRIBED ABOVE HAVE BEEN RENDERED AND THAT THE BILL IS DUE AND UNPAID, AND REPRESENTS THE ENTIRE CHARGE FOR SERVICES RENDERED TO THIS PATIENT UNDER THIS PROGRAM. DUE ‘, SC-J-ET 10-61 5M MET Dentisl's "3 Dat- Participating Dentist List MICHIGAN DENTAL SERVICE CORPORATION PARTICEEATING DENTIST NUMBERS ASSIGNED Number Dentist ' 8 Name Dentist '3 Address FORM Ba 47 Treatment Voucher Correction Form CDS DENTAL CARE PROGRAM - REQUEST NOTICE PATIENT'S NAME EMPLOYEE GROUP DATE [__ FORWARD X—RAYS. STATEMENT BEING HELD IN THIS OFFICE. BE THE ENCLOSED DENTAL CARE STATEMENT IS BEING RETURNED TO YOU FOR THE REASON SHOWN. DOCTOR'S SIGNATURE. \ PATIENT'S SIGNATURE. INDICAT'E DATE EACH SERVICE PERFORMED. IF SERVICE NOT RENDERED PLEASE DELETE. CI DEIEI OTHER. STATEMENT BEING HELD IN THIS OFFICE THANK YOU FOR YOUR PARTICIPATION AND COOPERATION. ( ) D CALIFORNIA DENTAL SERVICE CDS - 118 P.O. BOX 3736, RINCON ANNEX SAN FRANCISCO, CALIF. 94119 48 Treatment Voucher Correction Form CDS DENTAL CARE PROGRAM - ADJUSTMENT NOTICE PATIENT'S NAME EMPLOYEE GROUP DATE ‘_ L YOUR STATEMENT FOR DENTAL SERVICES ON THIS PATIEN ORIGINAL FEE NEW FEE PATIENT PAYS BALANCE C.D. 5 USE ONLY LESS ‘ c.n.s. PAYS 9 T HAS BEEN ADJUSTED FOR THE REASON SHOWN BELOW. PLEASE REFLECT THIS ADJUSTMENT IN YOUR BOOKKEEPING RECORDS. THANK YOU FOR YOUR PARTICIPATION AND COOPERATION. CDS 119 (2M 12/63) D CALIFORNIA DENTAL SERVICE P. 0. BOX 3736, RINCON ANNEX SAN FRANCISCO, CALIFORNIA 94119 49 Treatment Voucher Correction Form Michigan Dental Service Corporation 405 Stoddard Bldg. Lansing 23, Michigan Examination and Treatment Vaucher # for is not complete for the reason checked below. Please make the necessary change or correction and return to the MDSC Business Office as soon as possible. () () () () () () () () () 50 Dentist's signature not present. Date of last previous care (from any source) not indicated. Tooth number not indicated on item #___. Surfaces involved not indicated on item #_____. Restorative material used not indicated on item #____. Date service performed not indicated on item #____. x-rays did not accompany this form. Please return Copy $ . By . Michigan Dental Service Corporation Service Review Form REVIEW AND CONSULTATION REPORT D CALIFORNIA DENTAL SERVICE TO- FROM P. 0. Box 3736. RINCON ANNEX SAN FRANCISCO 19, CALIFORNIA Date Re- GROUP This case has been referred to the review committee of the Please render necessary emergency services only. You will be advised as to further disposition of this case. CALIFORNIA DENTAL SERVICE REVIEW COMMITTEE Attached is a copy at a dental statement received on the above-named patient. |:] We ask that you review the case to determine whether or not the fees charged are reasonable for the area in which the dentist practices. I: We ask that you review the case regarding the plan of treatment. CALIFORNIA DENTAL SERVICE REPLY —_ Date: SIGNED cns FORM [35 (m [213) ©®® 51 Service Review Form SCREEN'NG REPORT (To be completed by screening dentist) Patient's name: Employee: Address: Group: Telephone: Dental services were provided the above named patient in accordance with the enclosed treatment plan. Questions:(to be answered by patient) I. Are you pleased with the dental services recently received under the CDAS program? YES NO Were you treated courteously by both dentist and nurse? YES NO What was the amount of the fee (if any) which was paid to the dentist? § Comments on above: Questions: (to be answered by screening dentist) According to the standards of accepted dental practice; are the ser ices which have been provided this patient: Satisfactory Unsatisfactory If unsatisfactory. are they so because of: Explain: cdas-l06 52 Poor quality Unsatisfactory case planning Fee abuses Questionable integrity Signature: Screening Dentist Service Review Form Michigan Dental Ser'sz-ice Comgfigfiga‘tion » 405 STODDARD BUILDING, LANSING 23, MICHIGAN TELEPHONE 489-5227 so A fundamental part of our agreement with provides that periodic checks are made of the dental care provided under the program. This check is accomplished by selecting a random sample of patients treated and having our dental consultant actually examine and review the dental care received under the program. Your name has been selected from among those who have received dental care under the program. Will you please arrange to be at the at on ? This appointment will be for examination only and will take about 15 minutes. It should not be considered as a reflection on the dental care provided by your dentist. It is an effort by Michigan Dental Service and to assure you that you are receiving dental care of the highest quality. incerely, MICHIGAN DENTAL SERVICE CORPORATION Robert L. Fitzke Executive Director RLF:sm 53 Service Review Form MD Michigan Dental Service Corporation 5‘ : 405 STODDARD BUILDING, LANSING 23, MICHIGAN TELEPHONE 489-5227 As you know, our agreement with the provides for periodic review by our dental consultant of a random sample of cases treated under the program. This review has been established to ensure that individuals treated under group programs receive care consistent with that provided to the general population. The next review is scheduled for at . The random sample selected for this review includes your patient(s). Will you please forward to MDSC the radiographs Qmounted) taken of this (these) patient(s) on 7 They will be returned promptly following the review. Every effort has been made to ensure that the review is conducted on the highest professional level. The dental consultant will be furnished with a summary of the work done, however, the identity of the dentist will NOT be included. The consultant’s report will be submitted directly to the Professional Advisory Board of MDSC--also without individual dentist identity. If you have any questions about this procedure please call or write us. Your cooperation will greatly facilitate our quality control efforts and will do much to strengthen and enhance the professional image of dentistry in Michigan. Sincerely, MICHIGAN DENTAL SERVICE CORPORATEON Robert L. Fitzke Executive Director RLF:sm Service Review Form MICHIGAN DENTAL SERVICE CORPORATION SCREENING REPORT Patient's Name: Age: Address: Patient No. The following dental services were provided the above named patient under the Kaydon Dental Care Plan. Tooth No. or Surfaces Material Date of Service Letter Involved Used Service 10. Screening Dentist's Statement I have examined the above named patient. According to professional standards of sound dental practice¢it is my opinion that the services which have been provided this patient are: (check one) 1. Satisfactory 2. Unsatisfactory If unsatisfactory, it is due to: 1. Poor quality 2. Unsatisfactory case planning 3. Questionable Judgement 4. Other (specify) CommentsI ExplanationsI Remarks: Signature: Screening Dentist 55 9S TO BE COMPLETED IN DUPLICATE BY PARTICIPATING DENTIST. BOTH COPIES TO BE PRESENTED BY PATIENT TO SPE- CIALIST. PATIENT ADDRESS__________.—___ DATE REFERRED I.L.W.U. LOCAL NO. THIS PATIENT IS AN ELIGIBLE MEMBER OF A GROUP COVERED BY THE W.S.D.S.C. AND IS HEREBY REFERRED TO DR. FOR COMPLETION OF DENTAL SERVICES NOTED ON THIS FORM. NAME OF DENTIST ADDRESS____________—_— SIGNATURE_____.___—————- WSDSC FORM NO. 002 Specialty Services Referral Form WASHINGTON STATE DENTAL SERVICE CORP. 220 MEDICAL-DENTAL BLDG. ° SEATTLE I. WASH. ‘ PHONE MU. 5280 SPECIALTY SERVICES REFERRAL FORM D UPPER DECIDUOUS NM “57 x”... DECIDUOUS \«5 INDICATE HERE SERVICES TO BE COMPLETED BY SPECIALIST TQBE COMPLETED BY SPECIALIST: I HEREBY CERTIFY THAT THE APPROVED SERVICES LISTED ABOVE HAVE BEEN PER- FORMED AND PAYMENT IS DUE AND PAYABLE. SIGNATURE OF DATE SPECIALIST SPECIALIST TO RETAIN PINK COPY AND FORWARD WHITE ORIGINAL TO W.S.D.$.C. OFFICE FOR PAYMENT. Eligibility Verification Postal Card ( THIS SIDE OF CARD Is FOR ADDRESS) MICHIGAN DENTAL SERVICE CORPORATION 430 Stoddard Building LANSING 23, MICHIGAN Face Michigan Dental Service Corporation NAME AGE ADDRESS has today requested an appointment for treatment under the. -dental program. Will you please inform me promptly if this patient is eligible for care under this program? Sincerely yours, D.D.S. Address: Date______._ Telephone Number FORM F Back 57 Dental Program Utilization Statement DENTAL PROGRAM UTILIZATION STATEMENT FOR THE PERIOD Group Date Address I. Summary of Charges to Account During Period Deposit for Regular Care $ Emergency Care Only \H Total $ \ i Administrative Charge $____________.__. Total Amount II. Individuals reporting during the period for dental service for the first time in this contract year or for emergency care only: Regis- Emergency Tatient's Parent or ~tration Deposit Care Name Subscriber No. Reguired Only S 6 FORM C 58 Monthly Statement of Amounts Vouchered STATEMENT OF AMOUNTS VOUCHERED BY DENTISTS FOR THE MONTH OF Date Group Address Amounts vouchered by dentists during the month for services rendered: Regular Care $ Emergency Care Only Total $ ———-——-——-—.___ FORM D 59 Form for Non-authorized Treatment VMichigan Dental Service Corporation 405 Stoddard Bldg. Lansing 23, Michigan Re: Treatment has not been authorized for the following reason: ( ) Examination fee payable only upon initial visit for examination, diagnosis and treatment planning. ( ) Treatment requested is not covered by this program. ( ) Use of gold is not authorized in this case. ( ) Please indicate plan of treatment using Fee Schedule nomenclature and Procedure Code numbers. ( ) Please clarify ( ) See reverse of Examination and Treatment Voucher. () By Michigan Dental Service Corporation 60 Participating Dentist Index Card (City or Town) Dentist’s Name Street Addreu Office Phone Date Participation Began Termination Date REMARKS: Last First Specialty Middle Dentin No. FORM Bb—PARTICIPATING DENTIST MICHIGAN DENTAL SERVICE CORPORATION 61 APPENDIX E Selected References on Dental Services Corporations I. General Discussion Besdine, Matthew. The dental service cor- poration, an effective instrument for pro- viding dental care for groups in the State of New York. N.Y.S. Dent. J., 25: 361— 3, Oct. 1959. Brown, R. 0., Jr. Some of the economic con- siderations in developing prepaid dental care programs. N.Y.S. Dent. J ., 27 : 26—9, Jan. 1961. Cahan, H. N. What the dental service cor- poration will mean to the dentists of New Jersey. N .J.S. Dent. Soc. J ., 34: 305—6, 311, Apr. 1963. Dixon, F. G. Dental Plans. Iowa Dent. J ., 48: 168—73, June 1962. Dixon, F. G. The dental profession’s plan: The dental service corporation considera- tions in the development of programs. Am. Dent. A.J., 66: 24—31, Mar. 1963. Dollar, M. L. Role of dental service corpora- tions in dental insurance. Ann. Dent., 2— 8, Mar. 1964. Hoppe, H. O. The Wisconsin Dental Service Corporation. Wis. S. Dent. Soc. J., 39: 226—8, Sept. 1963. Lentchner, Emil. The concept of a New York dental service corporation. N.Y.S. Dent. J., 27: 444—50, Nov. 1961. Lusterman, E. A. The scope and significance of the dental service corporation. N .Y.S. Dent. J ., 30: 124—6, Mar. 1964. Miller, S. L. The dental service corporation, a report. Ala. Dent. A.J., 44: 9—11, Oct. 1961. Metzner, C. A. A factual basis for prepaid dental care. First Annual Conference. on Dental Health, Mich. S. Dent. Asso., 1960 Workshop on Prepaid Dental Care. Pro— ceedings. 53—60, Jan. 1960. Michigan Dental Service Corpora— tion policies. Mich. S. Dent. A.J., 43: 114— 7, Apr. 1961. Ryan, K. J. Profession responsibility for the development and guidance of dental service corporations. Am. Dent. A.J., 66 : 32—7, Mar. 1963. US. Department of Health, Education, and Welfare, Public Health Service. The den- tal service corporation; a new approach to dental care. (Public Health Service Pub- lication No. 570) Washington, Government Printing Office, 1958. 70 p. II. Organization Carr, J. G. The dental service corporation and the New Jersey Dental Society. N.J. S. Dent. Soc. J., 34: 309—11, Apr. 1963. 63 Conway, B. J. Developing a dental service corporation: Education and control of’ member participating in group plans. Mo. S. Dent. A.J., 38: 11—7, Mar. 1958. Dental service corporations and fee schedules. Canad. Dent. A.J., 29:244—5, Apr. 1963. Dixon, F. G. California’s dental service cor- poration: Its development and potential. Am. Dent. A.J., 64:362—9, Mar. 1962. Dixon, F. G. Dental service corporation; its functions as a working mechanism. Calif. S. Dent. A.J., 39: 475—82, 519, Dec. 1963. Eilers, R. D. Problems confronting the orga- nization and growth of a dental service cor- portion. Am. Dent. A.J., 67:82—94, Dec. 1963. Friedrich, R. H. Planning an effective den- tal service corporation. N.Y.S. Dent. J ., 26: 247—52, J une—J uly 1960. Marquer, V. B. Dental service corporations. La. S. Dent. A.J., 20:3—5, 19—21, Summer 62—Spring 63. Pelton, W. J. Provisions and safeguards of dental service corporation plans. N.J.S. Dent. Soc. J., 8—14, 18, July 1959. Pollack, Joseph. The dental service corpora- tion in New Jersey. N.J.S. Dent. Soc. J ., 34: 30341, 311, Apr. 1963. Rutledge, C. E. California Dental Service Corporation. First Annual Conference on Dental Health, Mich. S. Dent. Asso., 1960 Workshop on Prepaid Dental Care. Pro- ceedings. 30—3, Jan. 1960. III. Administration Brust, W. P. Dental service corporation— philosophy and administration. Tenn. S. Dent. A.J., 40 : 79—88, Apr. 1960. Campbell, R. H. Fee surveys and schedules: An appraisal. First Annual Conference on Dental Health, Mich. S. Dent. Asso., 1960 Workshop on Prepaid Dental Care. Pro— ceedings. 47—52, 60, Jan. 1960. Chuljian, G. T. The role of dental society sponsored plans in administering group purchase of dental care. Am. Dent. A.J., 60: 61—7 1, Jan. 1960. Dixon, F. G. Administration and manage- ment of a dental service corporation. Mich. S. Dent. A.J., 43: 297—303, 306, Nov. 1961. Hoggard, F. M. The Michigan Dental Serv- ice Corporation; a review of objectives and operation to date. Mich. S. Dent. A.J., 44:2—9, 51, Feb. 1962. Rowan, J. C. and Haywood, Alice. The den- tal service corporation; Oregon report. (Public Health Service Publication No. 896) Washington, Government Printing Office, 1962. 26 p. Ryan, K. J. The dental service corpora- tion—what Michigan did. N.J.S. Dent. Soc. J ., 33 : 267-7 6, 308, Mar. 1962. Sher, Joseph. Prepaid dental care—a com- ing trend. Textbook for Welfare and Pen- sion Trustees and Administrators, Milwau— kee, Milwaukee Publishers, Inc., 1962, 462 p. (pp. 41—6). Smith, Q. M. and McDonald, M. J. Dental serviCe corporation: California report. Pub. Health Rep, 77 :919—27, Nov. 1962. IV. Legal Condon, W. T. Legislative problems of a dental service corporation in New York. N.Y.S. Dent. J., 25 : 363—6, Oct. 1959. Conway, B. J. Relation of State laws to den— tal health service corporations. Am. Dent. A.J., 54: 194—7, Feb. 1957. Lamay, W. L. The dental health service corporation from a lawyer’s Viewpoint. Am. Dent. A.J., 54:198—205, Feb. 1957. Rooks, J. G. Legal aspects of group dental care programs. Tex. Dent. J ., 75:55—67, Feb. 1957. Walden, D. J. The dental service corpora- tion. Colo. S. Dent. A.J., 40-2, Sept. 1962. US. GOVERNMENT PRINTING OFFICE:1965 0—763-660 _ it: fiat}? . {1:5, :2!.};1§.r:.r;: Public Health Service Publication No. 1274 u.c. y Wm: (302529560?