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What Is the Difference Between HMO and PPO Dental Plans?

Dentistry21 -- When choosing health plans, understand the critical differences between HMOs and PPOs, not just the coverage differences usually presented by insurance companies.

If your employer offers dental benefits, or if you are shopping for them 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 who 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 doctor's overall performance is acceptable.

2. HMO plans

When it comes to a general dentist, the way insurance companies usually pay is called capitation payment. This means they sign a contract with a doctor for a certain number of people (let's say 500 people). Then they pay the doctor a monthly payment for each patient (On average $1.00-$6.00 per person). In return the insurance companies expect the dentist to perform certain procedures for free and others at a discounted rate.

When you think about it, you realize insurance companies practically 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.

Become more familiar with the system and you realize why some dental offices react strongly when you call them for appointments with 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 sign up with HMO plans. This has resulted in lowering the quality of service across the country.

So the next time you think about selecting an insurance plan, keep in mind the way doctors are reimbursed. You should not make your decision based solely on the list of co-pays insurance companies give you. Otherwise you may end up paying much more for a lower quality of service in the long run.

For more information, visit http://dentistry21.com/public.

Dentistry21.com is a comprehensive dental resource that contains dental plan information. Compare and buy a dental plan that suits you by visiting www.Dentistry21.com.

© 2005 Dentistry21.com

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The views and opinions expressed in these articles do not necessarily reflect those of College Central Network, Inc. or its affiliates. Reference to any company, organization, product, or service does not constitute endorsement by College Central Network, Inc., its affiliates or associated companies. The information provided is not intended to replace the advice or guidance of your legal or medical professional.