When used in relation to health or dental insurance, the term gatekeeper describes the person in charge of a patient's treatment. Anyone who receives health insurance coverage in the form of a managed care plan, is assigned a gatekeeper or allowed to choose one.
AARP DeltaCare is such a plan - This is the AARP DeltaCare plan in Georgia -
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- Choose a Contract Dentist facility from the DeltaCare USA network directory that is most convenient for you. A list of Contract Dentists is available at deltadentalins.com or by calling Customer Care at 877-522-9156.
- Complete the “DeltaCare USA Enrollment Application” and be sure to add your selected Contract Dentist’s name and facility ID number. If you fail to select a Contract Dentist or the Contract Dentist selected becomes unavailable, we will request the selection of another Contract Dentist or will assign you to another Contract Dentist.
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What is the DeltaCare USA Plan? This Plan provides Benefits through a convenient network of Contract Dentists in the state of Georgia. These Dentists are screened to ensure that our standards of quality, access and safety are maintained. The network is composed of established dental professionals. When you visit your Contract Dentist, you pay only the applicable Copayment for Benefits. There are no deductibles, lifetime maximums or claim forms. You must obtain dental services from or be referred for Specialist Services by your Contract Dentist.
The plan is very detailed as the example Certificate of Coverage indicates. There is a grievance process as with most insurance plans - even Medicare. But with this particular plan, you have to have a Contract Dentist to perform the work or refer you to another if needed.
Yes, when you sign up for any type of insurance - health, dental, homeowner, auto - you sign a contract with the insurer for the plan as described - then it is renewable usually annually.
Don't like the terms of the contract - just go somewhere else until you run out of options.
Sure, they are there to make money - they are private insurers. But the only way they can make money is by offering services at a cost that people like and can afford.
The more benefits, the more self-referral, the wider the network, if any, the lower the beneficiaries out of pocket cost - the more expensive the premiums
The higher the deductibles / co pays / co insurance, the lower the premiums
The more control which they can exert over your care, like a managed care plan (DeltaCare with a Contract Dentist) the lower the premiums
The less services provided or the fewer network providers, the lower the premiums.
It is NOT about who yells the loudest wins !
It's Always Something . . . . Roseanna Roseannadanna