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Direct Reimbursement [DR] and RiskManagers.Us

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Transparent Dental Benefits versus Confusion

[By Darrell K. Pruitt; DDS]


“If you are not a part of the solution, there is good money to be made prolonging the problem.” 

Company slogan- www.riskmanagers.us

Meet Mr. William Rusteberg

Today, I met William Rusteberg on the PennWell forum when he replied to the thread, “Why the long NPI, BCBS-TX?” which I copied below, along with my response which includes a plug for Direct Reimbursement [DR].


Mr. Rusteberg represents a company called RiskManagers.Us, whose specialty involves the benefits market, yet it is not exactly an insurance company – just like there is no such thing as true dental insurance.  RiskManagers.us is a firm that works directly with businesses to identify and develop cost-effective benefits packages – emphasizing transparency and fairness.  Now that is refreshing, friends! 

Defining RiskManagers.Us 

Here is how RiskManagers.us describes itself: 

“We do not work for an insurance company, we work for you. As an independent brokerage, and consulting firm we can represent any licensed insurance company in Texas, Colorado, Mississippi, Louisiana, Alabama, Illinois & Florida.”

If one visits the Web site’s “Reference Library,” here are some of the topics offered:

·         Self Funding – Need a second opinion?

·         Texas leads in transparency issues

·         Can’t get claim information? HB 2015 May Solve Your Problem

·         Medical Stop Loss Through a Captive

·         PPO Discounts – Games People Play

·         PPO Networks – Shell Game

·         Can Hospitals waive Deductibles in Texas?

“What is a NPI number?” 

Mr. Rusteberg’s initial question on the PennWell forum simply asked, “What is a NPI number?”  Following my explanation, he wrote: 

 “It seems that many of those in your profession would do well in accepting cash only, or directly working with employer groups who sponsor dental/medical plans on a direct pay basis. We have had good success in doing this for our clients – we have one employer in San Antonio who pays medical care providers directly and quickly – providers like it and the plan pays a fair and reasonable rate, not relying on a PPO network to “re-price” claims. We have done the same on dental plans, eliminating the insurance company, PPO network and paying dental care providers submitted charges directly and quickly. We see little or no trend increases on dental charges using this method. In my view, insurance companies interfere in patient – provider relationships in a financially detrimental way.”

Thanks for your reply.

My Response:

I like you, William; 

What you describe sounds like my all-time, personal favorite dental benefits plan. It is called Direct Reimbursement {DR}, and it not only gives the employer the unlimited capability to design a plan which reflects the level of commitment desired by the company, but most importantly, it naturally preserves quality of care by allowing employees unlimited freedom of choice in dentists.  And that’s as good as the market gets. 


In addition, since there are no NPI requirements for DR, employees are also permitted see dentists who decline NPI numbers for ethical reasons. That increases employees’ choice by 50% over BCBS-TX clients, according to recent information provided by the Healthcare IT Transition Group.


Little Management Needed

Just like the benefits plans you mention, with DR, very little money is spent on management because such policies are so simple and transparent that there is no room for profit-enhancing (wasteful) confusion used by unethical companies like BCBSTX, Aetna, Cigna, UnitedHealth, Delta Dental, United Concordia, and so many other members of the National Association of Dental Plans (NADP).


Without transparency and the invisible hand of freedom-of-choice, free-market competition for healthcare dollars disappears as fast as executive bonuses rise. We’ll see where it goes from here. It would sure be swell if a Direct Reimbursement representative takes interest in the conversation; anyone home? 


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12 Responses

  1. This is very informative and much needed information. I work as a benefit claims specialist and daily I’m battling with insurance companies about payments on claims submitted over 30 days. I am interested in more details on how to work as a DR representative. Is this a position that can be worked from home? My ultimate goal is to work from home and I enjoy working as a benefit claims benefit specialist.

    Please answer ASAP.
    Lana Brown


  2. Dear Lana
    I posted a Direct Reimbursement contact on the Web site your link provided. I hope this helps.


  3. Darrell,
    Would you please post the contact info, or link, for the rest of us.
    Thank you.


  4. For those interested in learning more about how Direct Reimbursement works, the ADA has a site that explains the benefit plan nicely.


    For business leaders and benefits professionals who have a more serious interest in the plan, I encourage you to contact Mr. Robert Rosen, the past president of the Consumer Directed Benefits Association. robr@dradmin.com . Robert is not only friendly, but he’s a great source of information about Direct Reimbursement.

    Thanks for your interest. This is encouraging …

    Darrell K. Pruitt; DDS


  5. Episode 2 – Doctrine of Slow

    Automatic telephone routing can make the search for a simple yes or no answer from dinosaurs like BCBSTX not worth the effort – depending on the amount of patient’s money that hangs in the balance. Insensitive and uncaring dental insurance companies actually budget for such windfall. After all, they’ve been doing it for decades. In fact, I bet that some time ago a BCBSTX executive received a bonus for stealing the cost-cutting idea of automating bureaucratic barriers from someone at Delta Dental or UnitedHealth.

    For a dentist to personally go out of his or her way to put up with automated aggravation even once as a favor to a patient is a sign of compassion. For a dentist to tolerate it again and again means that the special bastard must be after something more than money.

    This is why it is so convenient to have found BCBSTX employees, Sid “TweetDeck” Jones and Barbara “web” Web on Twitter. I hate telephone routing.

    April 30, 2008

    By almost 2 PM, I still had not heard from Joanie’s supervisor at BCBSTX. She was supposed to call this morning. That saddened me. If the supervisor had called my office, I would have been either the first or second person she spoke to. What’s more, the routing in my office is quick and reliable compared to BCBSTX’s.

    After successfully working through the qualification tasks, I was put back in touch with who I would soon recognize as Amber: She immediately asked, “Is this for medical or dental?”

    “This is dental.”

    “Identification number?”

    “Well, see, that’s the thing about it. I don’t have a contract. I’m a dentist, and I had a question that… I was supposed to be called back today from a supervisor. I think Joanie was the technician on the floor.”

    “Oh. Is this Dr. Pruitt?”


    “Oh… OK… If you would like, let me check and see what’s going on, as far as having someone call you back.”


    “I think Wilma, who’s our over all supervisor was supposed to call, but she might be out today.”


    “Can you hold for a second? (pause) The person who was supposed to call you back today was Wilma and she’s actually out sick. So she is still planning to call you tomorrow to answer any other questions that you had about your NPI situation.”

    “There’s not anyone that can talk to me about this today?”

    “Unfortunately, because she is the over all supervisor, she’s probably the one that can help you with that.”

    “Well, when can I expect her to call back? Morning? Afternoon? Or should I call back?

    “Well, she usually comes in about eight. So I can leave her a message. Is it better for you if she calls you in the morning or afternoon?”

    “I guess it doesn’t really matter. I may not be able to talk when she calls, but we’ll get back together.”

    “She’ll probably call you then in the morning.”

    “OK! … Alright, Amber. I appreciate it.”

    “You’re welcome. have a good day, Sir.”

    “Thank you.”

    A year ago, I thought it was odd that when Wilma calls in sick, the entire HIPAA department at BCBSTX stays home as well. For those who might rush to criticize that I am insensitive to pick on an ill person, I assure you that within 24 hours, Wilma was on the phone with me and a microcassette recorder. I have proof that less than a day later, Wilma’s appetite was healthy (Episode 3).

    At the end of episode 1, we were waiting on Sid – an on-again, off-again hairclub for men member – to get back in touch with us about details concerning the NPI number. Here are our exchanges on Twitter (earliest on top).

    Proots@BCBSTX Do dentists have to have NPI numbers to use your dental insurance? D. Kellus Pruitt DDS
    9:58 AM Apr 18th from web in reply to BCBSTX

    BCBSTX@Proots I believe it is required of all, but let me check and get back to you.
    9:46 PM Apr 19th from TweetDeck in reply to Proots

    Proots@BCBSTX Six days, no answer. I have no NPI number. Can BCBSTX clients use their dental insurance in my practice? Simple question.
    6:20 AM Apr 25th from web in reply to BCBSTX

    BCBSTX@Proots Just saw this. My reply didn’t go through, I guess. Sending again –link to get NPI. Yes, need to have it. http://bit.ly/nJ0MB
    9:40 AM Apr 27th from TweetDeck in reply to Proots

    Proots@BCBSTX Thanks for the reply. What happens if I don’t get an NPI number?

    Proots@BCBSTX Melanie, do not call me at work again. Can BCBSTX patients use dentists who do not have NPI numbers. Y or N.
    1:21 PM Apr 27th from web in reply to BCBSTX

    Proots- Is it possible that Twitter and BCBSTX are an imperfect match?
    7:51 PM Apr 27th from web

    Proots- BCBS got a mention on The Consumerist this morning announcing Twitter: http://bitly.com/hBrpg. I’m all over it.
    about 23 hours ago from web

    Proots- Now I will try to find out if BCBSIL and BCBSOK require NPI numbers to process claims. Won’t they be surprised.
    about 23 hours ago from web

    Proots@BCBSTX …Still awaiting your answer. Can patient with BCBSTX dental see dentist who has no NPI? Y/N. Simple answer.
    about 5 hours ago from web in reply to BCBSTX

    BCBSTXRT@Proots Just saw this. My reply didn’t go through, I guess. Sending again –link to get NPI. Yes, need to have it. http://bit.ly/nJ0MB

    about 2 hours ago from web

    Proots@BCBSTX You are saying that your insureds are limited to dentists with NPI numbers. Correct?
    about 2 hours ago from web in reply to BCBSTX

    Proots- How long before we hear from BCBSTX again, sports fans? I bet a dollar against the kitty – no reply before tomorrow.
    about 2 hours ago from web

    Proots- With Twitter, I can convene committees all over the nation. Now that’s progress.
    15 minutes ago from web

    Did I ever mention the great dental benefits idea called “Direct Reimbursement”? With DR, there is no confusion. Confusion in the marketplace is expensive for everyone except slow-moving bison.



  6. Look what I’ve serendipitously discovered on Twitter – Direct Messaging

    BCBSTX employee Sid Jones was the one who brought my attention to DM. Here’s something amusing about how that occurred: In his exchanges with me (before he got pissed and pouty), there were two occasions when he sincerely tried to tell me that he had forwarded some information for me that I may or may not have received … Oops.

    As I said, I only found out about the DM yesterday, and that is all I will say about that. I’m sort of embarrassed to admit that anything more than platform basics are often wasted on me. My needs are simple.

    Nevertheless, this Direct Message thing has potential. Now I can privately warn BCBSTX and others what I am going to do to them immediately before I do it. I like that. It’s sort of like the wind-driven sirens added to the wheel struts of Stuka dive-bombers.

    Here is what I secretly shared with my pal Sid early this morning:

    BCBSTX: You’re playing along wonderfully. Keep it up. Darrell
    about 3 hours ago

    BCBSTX: Get ready to explain D202 Summary of Benefits, Sid … or not.
    about 2 hours ago

    Here is what I followed it with on Twitter today:

    Proots@BCBSTX: Your D202 Summary of Benefits doesn’t mention NPI requirement. Are sales reps telling purchasers about it at all?
    -about 2 hours ago from web in reply to BCBSTX

    Proots@BCBSTX: If only 2/3 of Texas dentists have NPI’s, Delta clients with no NPI requirement have 50% greater selection of dentists.
    -about 2 hours ago from web in reply to BCBSTX

    Proots … but then, Delta Dental has its own problems. Right, Ari Adler?
    -about 2 hours ago from web

    Oh, yes. I think I can find a purpose for Direct Messaging; grins.

    Hey! Hot news! Ari Adler just mentioned Delta Dental on Twitter. I’ve been waiting for this to happen. Watch me make him earn his pay as a PR hack. More soon.

    Darrell K. Pruitt; DDS


  7. Lana, Mary et al

    I’ve been busy today. Meg Kaiser responded to my comment “Painful truths about dentistry” that I posted on PennWell. I posted this response.


    Meg I entirely agree that hygienists do not get the credit that they deserve for not only preventing patients from having more problems with their teeth and gums – for perhaps the rest of their lives – but also for being the most important customer interface in a dental practice. If the progress of a long-term relationship goes smoothly and according to the best of our professional intentions, a patient in my office will spend much more face time with my hygienist than with me, once I fix their restorative problems. That is the philosophy we follow and the ideal we strive for.

    I also believe hygienists deserve more than just praise. I think they should be paid accordingly for their responsibilities. These are not empty words. Since at least one of my hygienists reads most of what I write, he would agree that I pay more than most. But keeping good employees while at the same time providing the consistent, continuous care of a dental home to my patients is the most important thing we can do for their whole body health. And that is what it is all about.

    This means, of course, that I have to raise my fees accordingly, making them higher than most. Although, since it has been over a year since I updated my fee schedule, relative bargains at my office are fairly easy to find. I’ve been fortunate that volume has picked up in spite of the bad economy, but nevertheless I will have to raise my fees soon.

    Since topic-wise, I seem to have stumbled into a new vein to mine, and have already extended the transparency thing to my own practice perhaps much too quickly, let me say something about the high price of restoring implants that is sure to draw fire. I like fire: The market price, as well as the fee I currently charge for restoring implants is way overpriced for how easy it is these days. It’s no wonder that oral surgeons and periodontists are increasingly restoring implants themselves instead of sending the patients to general dentists. Let’s face it. It’s much more convenient for the patients than driving across town with impression copings in their mouths.

    (Wow! That should get a rise out of someone! Few things draw a crowd of otherwise stoic dentists quite like the smell of burning turf).

    Most consumers don’t realize that it takes more intricate and technique-sensitive work by the dentist to place a two-surface filling than to impress and cement three crowns on implants. The two-surface filling might cost $190, while the three crowns might cost $4,000. Even with lab fees of perhaps $600 for the crowns, comparable to material costs of maybe $20 for the fillings, as well as the higher exposure for the more expensive restoration, the differences in profit of over $3,000 could not remain in a true free market.

    But I’m not going to lower my fees on Monday for placing crowns on implants, unless I can also raise my prices on other, more common procedures to cover for my loss in income. And if I did so, it would immediately kill my practice, because insurance companies could and would justifiably tell each one of my patients that my fees would be “three times the usual, customary and reasonable limit.” Well, “reasonable” might arguably be a stretch. Nevertheless, patient complaints, fueled by their dental insurance companies, could possibly even attract the attention of the state board of dental examiners. No, I think I’ll leave things where they are for now until it makes business sense to change things.

    Let me put it this way: Those patients who purchase implant-supported crowns from me subsidize my patients who have insurance, and it’s a good thing they don’t read my stuff.

    But then, even if they were to stumble across this information, nobody else is about to change their fees either. Unrealistic pricing exists in dentistry because over the last three decades an artificial economy evolved from unnatural and unfair influences of dental insurance. I think the nation would be better off without dental insurance. Even the term is fraudulent. (That could draw some fire as well, but don’t expect to hear a peep from representatives of BCBSTX or Delta Dental – They wouldn’t dare; my pleasure).

    Dental benefits such as Direct Reimbursement make much more sense. I say to business leaders who are tired of hearing complaints from their employees: Try the free market for once. Trust them to choose the dentists of their choice rather than Delta Dental’s. Give money to employees for their dental needs. Not provider lists.

    Wow! Thanks, Meg. You came along and pulled my chain in a new direction. Since I had not yet pissed off enough people today, it felt good, actually.

    D. Kellus Pruitt; DDS


  8. Darrell,

    “Cash is King” as they say, and is an expression that refers to its’ importance in defining the financial health, prospects for economic success and value of any hospital, medical practice, dental clinic, or other healthcare business entity.

    A healthcare organization’s earnings become useful only when they are converted to cash. Furthermore, healthcare organizations that are expanding can acquire new assets only from free cash flow. Free cash flow, in turn, results from budgeting for excess cash flow and making prudent use of debt.

    And so, I am loathe to think of reasons why more doctors [especially GPs, internists, GYNs and primary care doctors like dentists, podiatrists, etc] are not adopting this DR strategy for modernity?

    Tradition, inertia, conformity, etc; no doubt!



  9. Direct Reimbursement Needs Help

    An article sponsored by Aetna was posted yesterday on http://www.benefitnews.com gleefully titled “Support for taxing health benefits slips” (no byline).

    In response, I submitted the following comment on the benefits industry news magazine. It’s been an hour or so, and my comment has yet to appear. The anonymous moderator of the Website may elect not to post my comment for employment reasons. If everyone at EmployeeBenefitNews is anonymous, it’s a sure-fire deal that they can control the content of information on the Internet for the benefit of their narrow world … That is until I post what they refused to acknowledge on my platform. Should I let “EBA Editor” know about this little practical joke, or should I just let him (?) discover it at some inopportune time on his own from an angry sponsor?

    Being ornery is just too much damn fun. I forget to eat.


    If dental benefits are taxed as income, for the first time in decades, employees will have an honest choice to purchase truly competitive dental plans that are not propped up by quirky taxation rules. The subtle federal subsidies that are now in place favor benefits companies while contributing nothing to improve value for employees. After all, the plans are marketed to their busy bosses, and salespeople are slick.

    When subjected to true market competition, the players in the benefits industry would either improve their products or risk their clients turning to Direct Reimbursement-type benefits plans where bosses can purchase a transparent, fair deal for once. And if the employees are not satisfied with the treatment their dentist provides, they are not limited to a preferred provider list of strangers’ names.

    Employees can take Direct Reimbursement wherever they want – same as cash. That means natural, free market quality control without huge administrative expenses. DR also keeps employees out of the HHR office with repeated complaints about their choices of dentists.

    D. Kellus Pruitt; DDS


  10. I will not be ignored

    I posted this on benefitnews.com because I think the Website which is sponsored by Aetna insurance is ignoring me. I can’t let them get away with that..

    Dear Employee Benefit Advisor (?):

    I am re-submitting my comment from yesterday that failed to be posted. Since I see that others, including EBA editor, have successfully posted their comments following your article with no byline. I’m sure I probably screwed up something in my attempt to post mine.
    (7/9/09) – If dental benefits are taxed as income, for the first time in decades, employees will have an honest choice to purchase truly competitive dental plans that are not propped up by quirky taxation rules. The subtle federal subsidies that are now in place favor benefits companies while contributing nothing to improve value for employees. After all, the plans are marketed to their busy bosses, and salespeople are slick.

    When subjected to true market competition, the players in the benefits industry would either improve their products or risk their clients turning to Direct Reimbursement-type benefits plans where bosses can purchase a transparent, fair deal for once. And if the employees are not satisfied with the treatment their dentist provides, they are not limited to a preferred provider list of strangers’ names.

    Employees can take Direct Reimbursement wherever they want – same as cash. That means natural, free market quality control without huge administrative expenses. DR also keeps employees out of the HHR office with repeated complaints about their choices of dentists.

    D. Kellus Pruitt DDS————————————

    Since it is not unusual for my comments to be lost before they can be posted, I almost always simulpost my comments on PennWell blogs and Medical Executive-Post.


    The one I am re-submitting today actually seems to be fairly popular on both. If “EBA Editor” is the anonymous author of this piece titled “Support for taxing health benefits slips,” all I need is his or her real name and I could help increase his (?) page-rank for free. I’m really good at that.



  11. What cash only practices should be careful of when taking payments


    Hope Rachel Hetico RN MHA


  12. The direct primary care model is gaining traction

    Direct primary care is a retainer-based practice model that does not come with a standard set of rules like many other business models.

    Instead, there is a common set of goals or characteristics, and DPC practices are making their own rules as they go.


    But, is it right for you?



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