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Insurance, subscriptions, and apps: The changing landscape of patient payment options

Oct. 31, 2019
As dental practices struggle to keep afloat with insurance payments alone, new options such as membership plans and Chewsi are becoming more common. Ann-Marie DePalma provides this guide for dental hygienists on today's payment options.

Dental professionals are required to treat patients with the most accurate treatment and diagnostic code that the patient requires. Yet, patients only want to have the treatments "that insurance will cover." Insurance companies are requesting more and more documentation in order to approve certain procedures. When procedures are approved, they are either subject to downgrade of the procedure or the dental practice has to take large write-offs or adjustments. More and more restrictions are being placed on dental providers as to procedures and reimbursements. Although insurance companies have the ability to change fees or alter treatments, if a dental practitioner did the same, it would be considered fraud. Insurance companies, when pressed for information about benefits or fees, dismiss the information. As hygienists, what can we do to help patients receive the treatments they need and want? This article will review insurance and noninsurance options for patients and practices.


Third-party reimbursements, or dental insurance, became prominent in the late 1950s, 1960s, and 1970s. Employers offered employees the benefit of dental insurance similar to other employee benefits such as health insurance, paid time off, or pensions. Benefits ranged in the $750 to $1,500 range and still are the most common benefit amounts offered today, despite years of cost-of-living inflationary increases. Additionally, dental insurance is not "insurance" in the truest sense of the word. According to Dictionary.com, insurance is defined as "the act, system, or business of insuring property, life, person, etc., against loss or harm arising from specified contingencies such as fire, accident, death, disablement, etc., in consideration of a payment proportionate to the risk involved."1 Dental insurance is not protection against loss; it was designed to provide assistance to obtain needed dental treatment.

Over the years, patients have been educated to think that insurance covers everything, which it may have in the beginning, but as practice operational costs have increased, third-party reimbursements have not kept pace. In today’s dental practice, patients are responsible for more treatment co-payments or the practice is required by the third party’s contract to reduce fees by adjustments or write-offs. Dental professionals are caring individuals and want to provide the best for patients, but dentistry is a business, and when any business has to reduce fees with increased costs, the financial stability of the business is jeopardized. While many dental practices have opted to no longer participate in third-party networks that offer high fee adjustments, others have remained for fear of losing patients because the practice does not take the patient’s insurance.


For those practices that wish to remain in-network or for those looking to decrease insurance dependence, there are a few options. Subscription services are exploding in everyday life. From Netflix to meal planning subscriptions, many people are using subscriptions for a variety of things. Dentistry has recently entered the subscription market. There are a number of companies that provide patients and practices with subscription services. Practices also have designed their own subscriptions as well, but these should be vetted to conform to state regulations.

With subscription services, patients pay a monthly or annual fee and receive a set number of diagnostic and preventive services per year along with discounts on other services. By paying a subscription fee, practices realize the actual income while providing patients with the opportunity to obtain treatments that have been recommended—all at a price that patients can afford. Patients with insurance cannot take advantage of subscription services, but often the cost of the subscription is less than payroll deductions and treatment co-payments.


Another option that is new to the market is Chewsi. Chewsi is an app that the patient downloads and the practice enrolls in. Chewsi is not dental insurance—there are no limits or excluded services. Patients download the app for free then find a Chewsi practice and pay at the time of service. With Chewsi there are no premiums, monthly, or annual fees and no renewals. The practice doesn’t file any forms or receive rejections. The amount charged to the patient’s credit card, Flex Spending Account, or Health Spending Arrangement reflects savings based off the practice's actual fees, not an amount assigned by location or set by local insurance allowances.

Chewsi is a product of First Circle Solutions, a Rhode Island technology company focused on delivering solutions for today's healthcare marketplace.2 Over the first two years that Chewsi has been in existence, there are approximately 4,000 dental locations enrolled throughout Massachusetts, Connecticut, Rhode Island, and portions of New Jersey, New Hampshire, Iowa, and Hawaii, with plans of growing the network nationally. As dental insurance puts more restrictions on the practice in terms of what care is covered, more practices are joining Chewsi each month.

Chewsi can be used for patients who have insurance and for those who don’t. Patients with insurance can use Chewsi to pay for treatments that are not covered by their insurance plan because of frequency limitations, annual maximums reached, missing tooth clauses, additional prophylaxis and fluorides, night guards, or cosmetic services. Uninsured patients such as those on COBRA (Consolidated Omnibus Budget Reconciliation Act), who work part-time, and don’t qualify for employer benefits, are self-employed or are retired and no longer on employer-sponsored plans also can use Chewsi.

For practices, the process is simple. The practice enrolls in Chewsi; when the patient is in the practice receiving services, they use the app to pay at time of service. Upon enrollment with Chewsi, the practice submits its full practice fee for all treatments provided. To date, Chewsi has saved patients 15% to 25% and all services are eligible. On the day of service, the practice’s business team logs into chewsidental.com and submits the appropriate American Dental Association code with the full practice fee and the appropriate patient member ID. The patient will approve the charge, having enrolled with a debit or credit card upon enrollment. The practice receives electronic payments within 48 hours, thus improving cash flow. The practice saves on the merchant services fee when the patient pays through the Chewsi app. The patient payment amount includes a modest transaction fee reflected in the patient payment amount. The app provides the patient with a view of what the office charges and their patient savings. It's a win-win for the patient and practice.

Patients receive the treatments that are needed, feeling that they have received the best care at a fair price. The practice can enjoy increased revenue with no insurance involvement denying recommended treatments while increasing patient loyalty and new patients. Patients are learning about Chewsi through consumer marketing campaigns, such as advertising with the American Automobile Association (AAA) to reach its membership base.

The role of the dental hygienist

As dental practices struggle to grow and retain new patients and with insurance company reimbursements decreasing, teams have to be creative in finding ways for patients to afford recommended treatments. The importance of the oral-systemic connection grows each day, and as dental professionals we are bound to educate patients about their oral and systemic health. Having sound financial policies and products that allow patients to receive the needed treatments without sacrificing care options provides patients and practices with the best of both worlds.

Disclosure: The author was not compensated by the companies mentioned in this article.


  1. Insurance. Dictionary.com website. https://www.dictionary.com/browse/insurance. Accessed October 31, 2019.
  2. Products. First Circle Solutions website. https://www.firstcirclesolutions.com/Home/Products. Accessed October 31, 2019.

Ann Marie DePalma, MEd, RDH, CDA, FADIA, FAADH, is a technology advisor for Patterson Dental, a writer for RDH magazine, and an author in dental hygiene textbooks. She is the 2017 Massachusetts College of Pharmacy and Health Sciences Esther Wilkins Distinguished Alumni Recipient. She is a continuous member of the American Dental Hygienists' Association and an active member of the Massachusetts Dental Hygiene Association.

Additional articles

Patient education technologies for dental hygienists

Why in-house membership plans could replace ‘insurance’ (RDH magazine)

Dental fraud and the hygienist’s role (RDH magazine)