HMO practices and capitation checks.

[the2thdoctor]

Hi, everyone.

I have a question about practice management, HMO insurance and capitation checks.

A few years ago while working for a practice that accepted HMO insurance I remember one day when one of the front desk clerks mentioned that just on that one single day she had received $16K in capitation checks from HMO insurance companies / plans.

Can anyone share their experience with HMO plans and capitation payments or checks ? What is the range of reimbursement (minimum to maximum) and the average dental practices receive monthly in capitation checks or payments from their HMO insurance companies / plans ?

Thank you in advance.

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[endoaccess]

Maybe a few dollars/month/patient. It's not much. Look at some practice broker sites, the HMO offices for sale list the monthly capitation reimbursement.

 

[the2thdoctor]

In CA maybe a few dollars/month/patient. It's not much. Look at some practice broker sites, the HMO offices for sale list the monthly capitation reimbursement.

Thank you, endoaccess.

Considering many offices are signed up as providers with many different HMO plans / insurance companies, do you find it possible that a typical office may be able to receive $16,000 or more per month in capitation reimbursement ?

Do you have links to these brokers that have HMO practices with the capitation reimbursement listed ? I tried to find some but didn't have any luck.

Thank you again.

 

[endoaccess]

Yeah the big hmo practices could get that much. Get a bunch of people signed up and hope they never come in. If they do come in you basically lose money on any covered procedure you provide. So they upsell uncovered procedures to get full fee. For example, if the insurance only covers PFM crowns you sell them a "special all porcelain" crown so you can get paid. All patients need SRP and arrestin, never a simple cleaning. This is the HMO game and how all these places operate. And refer out all OS and endo since you can't upgrade.

I won't judge these dentists, but I would never refer and friend or family member their way.

I can't point you anywhere online, I've only seen them for sale in mailers.