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August 20, 2013

Howdy Gang,

 I'm back from vacation and ready to do some blogging!

Last time, I talked about the different kinds of dental insurance. Today, I'd like to comment on discount plans and dental HMO's. 

 One of the things that I really like about the dental community is that most dentists are very willing to offer their own discounts to patients that are not covered under any dental plans. Although the amount of any discount offered by a dental office will vary from office to office, those discounts are typically about the same as the "official" dental discount plans. So if you don't have a "regular" dental insurance plan, before you go out and spend $$ purchasing a discount plan, talk to you dentist directly. You might be surprised at how reasonable we can be. Unless, you are given a dental discount plan for free or as a bonus as part of your health insurance, you might want to take a pass on buying a discount plan yourself.

 The other kind of insurance plan that I'd like to touch on are the dental HMO's. I'm a bit hesitant to speak from the heart here because I don't want to offend anyone. Let me preface my comments by saying that their are some fantastic dentists and dental offices that do a great job at providing quality care for people under dental HMO's (or DHMO's). But after trying to practice myself in an office that accepted DHMO's, I quickly determined that I was not one of them.

Most DHMO's are capitated plans, meaning that the dental offices that are providers are reimbursed by the DHMO on a monthly, per person basis. Other than the monthly-per-person-signed-up-with-the-office check, nothing is submitted to or paid out from the insurance company. For check ups and cleanings, no money is exchanged. The work is done for "free". Any active treatment carries with it a very small patient co-payment that is just enough to cover supplies and sterilization. So how do dental offices survive in an environment of free cleanings and minimal co-payments when something needs attention? Answer: volume and inactivity. If enough people sign up for your office, you will get a big, fat capitation check each month without doing anything. And if no one calls for an appointment (and half of America does not go to the dentist on a regular basis) the monthly check can go a long way.

And that's where I fell off the wagon. It became apparent to me that I would be the most successful under a DHMO if I tried to NOT see patients or at least make it difficult to have access to care. This went against everything that I felt was important as a care provider. And again, I am speaking from my own experience. There are those that make this work and provide amazing care. But for me, my office not only had patients in DHMO's, but also patients with more traditional types of plans. I found it very difficult to treat everyone the same. Patients should have equal access to care no matter what kind of insurance that they have. So soon after starting my own practice, I was out of the DHMO business. 

As I mentioned in my last blog, most DHMO's will only offer coverage if the patient goes to the office that they are signed up with. The patient will be given a list to choose from when they get the insurance and in order to be covered, they have to choose from that list. If your chosen dental office is not a provider and you can't sign up with their office, then you can not be a patient there and have dental coverage. Plans that restrict a persons access to care should be looked over very carefully before committing to them. There may be a better plan that is better suited for today's dental patient. Maybe you can read about them next week.... right here.... see you then.

 

Posted by FVDC Office on August 20, 2013 at 7:13 PM
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August 6, 2013

Howdy Gang! The number one question that we are asked when a new patient calls our office is whether or not we take their insurance. There are some misconceptions about dental insurance that I would like to address over the next few weeks. This entry will focus on the different types of dental insurance. The five main types are Usual & Customary, PPO, HMO, Direct Reimbursement, and Discount. Here is how those shake out....

Usual & Customary: This is the carte blanche of dental insurance plans and easy to understand. You may choose any dentist or dental specialist that you like and your benefits will be the same. No provider restrictions. Benefits are based on percentages and have annual maximums.

PPO: Most insurance carriers offer dental PPO's. Under this type of plan, the insurance company has negotiated a reduced fee schedule with certain dental offices who are willing to do the dentistry at a reduced fee. They are termed "participating providers." Members can take advantage of those reduced rates by going to one of those offices. Members can still go where ever they want, but get better benefits and lower fees by going to someone "in the network." 

DHMO: Dental HMO's are a type of plan where each member gets a list of participating dentists and must choose someone on that list. Co-payments in those offices are greatly reduced or not charged at all. This is great for the patient as our-of- pocket expenses will be minimal. The trade off is that the member has zero coverage if the dental treatment is rendered by someone outside of the DHMO network. 

Direct Reimbursement: This is not true insurance. An employer agrees to reimburse an employee up to a certain limit for any out-of-pocket payments for dental treatment. No questions asked. No provider restrictions. This eliminates the insurance company as the "middle-man."

Discount Plans: This is also not a true insurance plan. Certain dental offices have agreed to discount their fee's by usually 10-20% for services rendered. No insurance submissions. Just a discounted fee. 

 Which plan is best? What are the advantages and disadvantages of each? Tune in next week for some answers... Until then, keep brushing!

Posted by FVDC Office on August 6, 2013 at 6:31 PM
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