HMO Infiltrates Dentistry

[Kach]

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Hey everyone,
Many agree that the ADA has done a decent job in preventing "HMOs" from infiltrating dentistry, but what exactly does this mean? Afterall, since many people use dental insurance to pay for their procedures haven't "HMOs" already infiltrated? Also, if, in fact, HMOs have been held at bay, will this last?

To you doctors out there, do dental insurances pay your full price? If not who pays the rest of the cost and what happens if you get stiffed?

 

[1992Corolla]

I wrote an article that reviewed an article that...shoot, just read it:

http://dmdstudent.com/2007/08/09/article-highlight-beware-the-growing-allure-of-managed-care/

 

[DrJeff]

"HMO Dentistry for Dummies" version here:

If you as a dentist DON'T sign up to participate with a HMO plan that an insurance company offers, that limits the amount of providers that participate with it and its REDUCED reimbursement fees it pays you. If not enough dentists participate, then 1st the employer that offers this plan to its employees hear's ALOT of upset employee complaints about their dental plan, then the insurance company hears about it in the form of the potantial of loosing a client. If this happens on a large scale, then the HMO plans and their fee schedules go away.

Compared to medicine, dentistry is a small player in the healthcare game. This puts our profession at an advantge when it comes to the HMO style plan. Just remember, if there aren't any participating dentists, then the HMO plan goes away.

 

[MacGyver]

Last I read, less than 50% of the market in dentistry is insurance-controlled.

Compare that to medicine, which is over 95% insurance-controlled.

You guys better hope that Hillary doesnt jump on the bandwagon of "universal dental care" or you will get screwed just like us.

Given the option of "free" govt dental care vs paying out of pocket, its a no-brainer, and you guys will lose all your patients to the public sector, forcing you to become a govt insurance ***** just like the docs.

Of course, there's always a few who will escape into the free market world of cosmetics, but I'd say less than 20% of you can get into that market. 80% of dentists will become govt slaves.

 

[Kach]

Last I read, less than 50% of the market in dentistry is insurance-controlled.

Compare that to medicine, which is over 95% insurance-controlled.

What's the source on this, mac?

 

[DrJeff]

What's the source on this, mac?

Pretty close to what I see in my office. We're pretty close to 60% with dental ins, and 40% without

 

[Kach]

Pretty close to what I see in my office. We're pretty close to 60% with dental ins, and 40% without

To all the dental specialists out there (orthos,endos, omfs,perios, etc)would ya mind describing the ratios of insurance to cash patients in your practices?

 

[S Files]

from my very limited understanding, the real enemy is not insurance, but these hmo / dmo plans. it's great that the pt has $1000 towards dental care, and some towards preventive and they can use that, and then supplement with cash if needed. but the problem is when insurance companies try to force dentists (especially the young and in debt ones) to accept their measly payment plans at reduced fees. as DrJeff said as long as we stay away from these reduced fee plans, they will go away.

 

[makushin]

My experiences with dental insurance are that dentists usually accept it and make the patient pay the difference between what the insurance covers and what the fees are. I don't really see how this is negative, as they are still getting the full fee, and from people who often wouldn't normally afford it.

 

[Daurang]

My experiences with dental insurance are that dentists usually accept it and make the patient pay the difference between what the insurance covers and what the fees are. I don't really see how this is negative, as they are still getting the full fee, and from people who often wouldn't normally afford it.

Usually, if you accept an insurance you also must accept their fee schedule.

 

[I'mFillingFine]

Usually only the large (corporate) dental chains would even consider accepting HMOs. Why would a dentist voluntarily accept an automatic $5/month per patient, regardless of what work is done?

 

[S Files]

Usually, if you accept an insurance you also must accept their fee schedule.

hmm...this may be a regional thing. my dentist does the "pay the difference" thing. he's not on the insurance company's provider list, but does accept patients with several insurance plans who understand his policy