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23 Feb 2008 03:21:36 | Dentistry21 Editorial Team
You can re-publish this article as long as you provide clickable
links to the source. A courtesey email to
marketing@dentistry21.com will be appreciated. What is the
difference between HMO and PPO dental plans? If your employer
offers dental benefit or if you are shopping for it yourself you
often come across two terms: 1. Dental HMO plans (DMO) 2. Dental
PPO plans To be able to make a correct decision you should know
the difference between the two, and I don't mean the coverage
difference that is usually presented by the insurance companies.
What I mean is the real difference. You should know how they pay
the doctors and which plans the doctors favor. Why? Because
eventually it is the dentist that will provide the service to
you and not the insurance company. So, no matter what the
insurance company claims their doctors have to do, your dentist
will treat you as he or she sees fit. To look at the issue from
the perspective of a dentist, let's see how they differ in terms
of payments to the doctors. 1. The PPO plans PPO plans, also
called preferred provider plans, pay doctors based on the
procedures they perform. In other words, for each approved
treatment or service performed by your dentist the insurance
company sends him a payment (assuming other limitations don't
apply). When you are talking about this kind of coverage, it
means the more your doctor does the more he is paid. Of course
there are checks and balances in place to make sure the doctors
overall performance is acceptable. 2. HMO plans When it comes to
a general dentist, usually the way the insurance companies pay
is called capitation payment. Which means they sign a contract
with a doctor for a certain number of people (let's say 500
people). Then they pay doctors a monthly payment for each
patient (Something around 1-6 dollars per person). Then in
return they expect the dentists to perform certain procedures
for free and some others at a discounted rate. When you think
about it, you realize practically they reward doctors who do
less! As far as the dentists are concerned if they are
performing a "covered benefit" they are losing money! The only
time they make money is when they perform a procedure that is
not covered by insurance. Getting more familiar with the system,
you now realize why some dental offices act strongly when you
call them for appointments having an HMO plan. The fact is that
insurance companies (being a large monopoly dealing with a
non-union crowd) have pressured many doctors (both in medicine
and dentistry) to sing up with HMO plans. That has resulted in
lowering of the quality of service across the country. Next time
you are thinking about selecting an insurance plan keep in mind
the way they reimburse the doctors. You should not make your
decision only based on the list of co-pays they give you. You
may end up paying much more for a lower quality of service in
the long run. Go to http://dentistry21.com/public for more
information.
About Author :
Dentistry21.com a comprehensive dental resource that contains
dental plan information. You can compare and buy a dental plan
that suits you.
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