Why Have Dental Insurance?
Discount or Referral Plans
Traditional and Indemnity Insurance
Capitation Dental Plans (DHMO's)
What Does My Plan Cover?
Preferred and Exclusive Providers
Get the Most out of Your Insurance
Choosing a Plan
Where Can I get Insurance?
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Capitation Dental Plans(Dental Health Maintenance Organizations) Dental HMO’s Managed dental care programs are popular, especially if you have your insurance through your employer. A Capitation Dental Plan, or Dental HMO (DHMO) operates a great deal differently than Tradition or Indemnity Insurance. In a DHMO a dentist or dental clinic contracts with the insurance company to provide services to its clients. The company then in turn refers patients to the dentist. Limited Choices Your choices are limited in certain areas and your co-pay fees may depend on some of the choices you do make. Many DHMOs have closed panels – meaning they offer you a list of dentists to choose from that they have chosen. You pick a dentist from the list and go to him for all your care. Some do offer you the option of choosing a doctor not on the list, but out of pocket expenses that you pay are going to be considerably higher than if you choose one that is accepted by the DHMO. What You Can Expect to Pay DHMO programs usually have an enrollment fee as well as monthly premiums. You will have a deductible as well as a co-payment or flat fee for each visit. There is an annual yearly cap on the amount the insurance company will pay so you can expect to pick up anything after that is met. Positive Points Being in a DHMO often means premiums are less because it is contracted care. The dentist agrees to accept a monthly payment per patient, no matter what treatments or services he provides, and the savings to the company are passed on to you. You do not have to mess with paperwork, your dentist takes care of it under this type of plan. Preventive treatments are almost always paid for 100% with no deductible. The Down Side If you are considering choosing a DHMO there are some things you seriously need to consider. How much does your policy cover if you have to choose outside their list or see a specialist? Also with DHMOs you often need to get a referral before you can see any kind of specialist and for certain types of treatments. Emergency care or out of town emergencies are not necessarily covered because the dentist may not be one the insurance company users. But one of the real concerns is the quality of care. If a dentist is receiving a flat fee each month per patient is he really going to knock himself out to provide the care your family may need? The only way he really makes money is to keep his own costs down as much as possible. This could mean less than adequate treatment, especially in areas requiring extensive or long term treatment. There is a danger in contracted care of a reduction in the level and quality of the care you receive. Check it Out If you decide to go with a DHMO or have no choice because of your employers choice of plans, make sure you thoroughly check out the dentist you choose. feedback@DentalInsuranceLocators.com |
