Employees of U.S.-based companies cross the border into Mexico every day to obtain dental treatment covered under dental insurance plans provided by their stateside employers. One dentist, Dr. Juan Pablo Eng, operates six clinics just inside Mexico with 38 dentists who have treated more than 40,000 U.S. residents in the past 18 years. Virtually all the patients at his clinics are U.S. residents, and about 65% of them are insured under their U.S. dental plans.

“It used to be around 80%,” Dr. Eng says, “but in the last three years the economy has resulted in a rise in uninsured patients.”

This bustling, international dental commerce and the employee benefits plans that support it are partly due to the growth in the Hispanic population in the United States. But it’s also reflective of a willingness by employers and employees to utilize their benefits programs in cost-effective and creative ways.

Dr. Eng’s DentiCenter clinics, in operation since 1991, are included in the United States provider networks of both Aetna and Delta Dental. For Delta Dental, the inclusion of Mexican clinics is part of its Hispanic initiative, which includes staffing its call centers with bilingual employees and helping Hispanic customers identify dentists in the network who speak Spanish. Delta Dental added Dr. Eng’s clinic to its network in 1993.

Jeff Album, vice president of public affairs for Delta Dental, says, “There’s a lot of opportunity for dental insurers in the Hispanic community because dental insurance is not common in Mexico or other Hispanic cultures.” He mentions that many Hispanics working in the United States have family members still living in Mexico who can be covered under their employee benefit plans. These family members can use the Mexican clinics approved by Delta Dental.

And for those Hispanics living and working in the United States, “Some are going to be more comfortable seeking care south of the border. We’re trying to accommodate those people,” Album says.

He adds that Dr. Eng’s clinic “is one of a very limited number in Mexico included in our network. In order to be contracted as a Delta Dental office, the Mexican clinics have to credentialed up to California standards. We do on-site assessments of procedures at the Mexican clinics.”

It isn’t only Hispanic workers in the United States who are traveling to Mexico to obtain dental work. “Our patients used to be about 70% Hispanic,” says Eng. “But recently we’ve had an increase in Anglos coming down, many of them age 55 and older.”

A prime motivator, as it is for those Americans seeking general medical procedures in other countries, is price. Dr. Eng says his patients pay approximately one-third of what they would for the same procedures performed near their homes in the United States. According to Dr. Eng, this cost differential can hold up even when factoring in the cost of transportation to and from the clinics.

DentiCenter owns a transportation company that books roundtrip van service from San Diego to the border towns of its clinics: Mexicali, Nuevo Progeso, Otay, Reynosa, San Luis R.C. and Tijuana. The transportation company also will arrange flights for those patients traveling by air to San Diego as well as hotels for those who need them. Arrangements are made using toll-free telephone numbers in the United States.

Many of those who travel the greatest distances from the United States to seek treatment at DentiCenters are uninsured. Dr. Eng uses the term “dental tourism” to describe these visits to Mexican clinics by uninsured U.S. residents. The number of these uninsured patients has been “rising dramatic­ally” in the last few months, he says. He provides an example of the economics of a recent treatment of an uninsured woman in her late 60s.

“She flew here from Georgia, arriving at the San Diego airport around 11 o’clock in the morning. We sent a DentiCenter van to pick her up and take her to Tijuana. We removed a couple of teeth, put in a bone graft and two implants and she was back on the plane at 6 p.m. She called us from Georgia around 11 p.m. to say that she was back home and all was fine.

“She had gone to a dentist in Georgia, who told her the procedure would cost about $12,000. She paid DentiCenter a total of $3,500. That included everything—the surgery, transportation and medications,” Eng reports.

Workers covered by group dental insurance can use the savings from treatment in Mexico to extend what is paid for under their maximum annual benefits. For example, according to Dr. Eng, having one crown made by a dentist in the United States might use up a $1,000 maximum under an insurance plan, whereas the DentiCenter clinics might be able to make four crowns for $1,000.

“Dental fees reflect the area you’re in,” Delta Dental’s Jeff Album says. The annual maximum of the plan doesn’t change depending on where you’re having your dental work done.”

The issue of lower fees in Mexico leads inevitably to questions about the quality of care. Album explains that auditors who are certified by the California Association of Dental Plans perform on-site inspections of the dental offices to assess cleanliness, sterilization procedures and other processes in place.

“We check the CVs (curriculum vitae) of every dentist who practices in those offices to make sure they are licensed, that they’ve had formalized education. Many of them have been educated in the United States,” Album says.

Dr. Eng’s business model provides something of contrast to local U.S. dental offices. While a dentist in the United States may have to reschedule an appointment because of a child’s soccer game, DentiCenter doctors sometimes schedule an entire family from the United States with appointments at the same time and arrange for the travel to get them there.

“We have nine to 12 dental chairs in each office,” says Eng. “We can have multiple appointments for the same family. We have doctors specializing in children, orthodontists, as well as others handling the usual adult procedures. So we can see everybody at one time. Of course it takes two or three hours to finish them all up.”

Entrepreneurism is alive and well in Mexico. And the U.S. employee benefits business is part of it.