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Medical Schemes
Tuesday, August 1, 2006
Broker opportunity

Dental Information Systems (Pty) Ltd (Denis) is the largest independent dental claims administrator in South Africa. It currently has seven medical aids as clients covering 1,5 million lives in dental insurance benefits. Following steady growth during the past 10 years, it now plans to expand its proven successful business model, as the market leader in dental benefit management.

Comments Dr Frans Coetsee Chief Executive Officer of Dental Information Systems, “We provide a set of insured dental benefits, managed by a rules-based management system. This enables costs to be effectively managed to the benefit of patients, the medical schemes and dentists alike.”
The Denis team of over 120 staff members includes six full time dentists, four oral hygienists, 27 dental nurses, various IT programmers and more than 50 Call Centre consultants. Over 2 000 calls are routed daily from both service providers and members to the call centres and over 100 000 dental claims are processed monthly.
Dental practitioners, who register with the Denis Online Facility, are able to bill directly into the system and receive immediate authorisation and payment. This saves practitioners significant administrative costs and enhances their practice’s cash flows.
The advantages for medical schemes are also immeasurable. All they have to do is pay a monthly upfront fee per registered member to Denis, thus transferring the underwriting risks out of their books. Denis becomes the administrator of all dental claims, while the scheme’s medical administrator would continue to look after all the other claims (for example, doctors, medicines and hospitalisation). By centralising the administration and settlement of all dental claims into Denis the medical aids enjoy reduced costs of covering their members and more skilled claims assessments, while knowing in advance the total costs of the dental portion of their medical schemes packages for the respective financial year.
Dental costs are becoming a huge risk for medical schemes with, for example, far too much resources going towards cosmetic work. Denis carries a database of each member’s dental history, and can assess each case and promote genuine claims quickly and efficiently.
In addition there are a number of benefits to members of schemes contracted to Denis. “There is also the Denis Smile Campaign,” says Dr Coetsee, “which is a wellness programme to educate patients about certain treatments in order for them to make informed decisions.”
Insurance brokers who specialise in medical scheme packages and healthcare services should also investigate the benefits of the programme on behalf of their clients. By Nigel Benetton
For further information please contact: Dr Frans Coetsee on Tel: +27(21) 6576500
 

Copyright © Insurance Times and Investments® Vol:19.4 1st August, 2006
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