Determination of utilization in a dental insurance plan

Abstract

Thesis (M.Sc.D.)--Boston University. Henry M. Goldman School of Graduate Dentistry, 1990 (Public Health Dentistry)Bibliography: leaves 39-40.The objective of this study was to determine and compare the dental care utilization of 37,000 New England employees, insured by Empire Blue Cross Blue Shield and Metropolitan Life insurance companies under dual option, preferred Provider ( Closed) Plan and Open Plan. This investigation was carried out by a random selection of 5,000 records of insurees. Comprehensive statistical analysis was performed to evaluate dental services provided through both dental insurance plans. Dental services were broken down by the ADA Procedure Code classification and service mix statistically examined in relation to Plan type ( Open, Closed), claim administrator (Empire, MetLife) and eligibility type (Employee, Spouse and Dependent). This sample comprised of members (employees), their spouse and dependents who, overall, formed a group of 2064 (41.3%) males and 2936 (58.7%) females. Of the total 5000 dental claims filed 1929 (38.6%) were through the Open Plan and 3071 (61.4%) through the Closed Plan. Specifically, for each dental procedure claims were counted with either Plan type