Seeing that I will be working soon, I want to understand the difference between HMO and PPO insurances. From what I understand, the way HMO works is that if you accept HMO as an office you automatically get a bunch of patients and get a fixed amount of money (usually around 6$/month) per head and sometimes you only get paid the 6$ for JUST THE PATIENTS THAT COME IN THAT MONTH. If these patients come in and need a bunch of dental work you basically end up losing money doing their treatment because you’re practically doing it at no monetary benefit in excess to the fixed monthly compensation per patient. Let’s say I end up working at a corporate office that accepts HMO and get 30% of production. If I do a bunch of fillings on an HMO patient I’d get 30% of either nothing or a small co pay right? Do HMO plans even require a co pay or is the work done at no charge?
PPOs
This type of insurance is better than HMO, but still not great. Your dental office negotiates with PPO insurance companies on fees for each treatment and when an agreement is reached you create a fee schedule. The fees in the fee schedule always pay you less money than you’d get doing the same procedure for a fee for service patient. At least with PPO you’re getting around 75% (or maybe more like 50%) of the full price you charge for the procedure, instead of basically nothing which is what you’d get from HMO. Patients with PPO insurance have to go to a dental office “in network” to enjoy their full benefits. This means an office that has agreed to honor the PPOs fee schedule. What if a PPO patient decides to go out of network? Will they still get PPO to help pay for the treatment or are they on their own?
The reason dentists accept these insurances is because it’s not a perfect world and you can’t expect to have a 100% FFS patient base. If you’re a Dentist with a new practice accepting HMO and PPO is a quick way to get a patient base. While your reimbursements are not good you’re better off doing work for less than full price than sitting on your thumbs all day and paying your staff by the hour for nothing.
This is just what I understand at this point. If someone with the knowledge I lack could answer my questions and correct all the incorrect points I’ve made I’d be very appreciative! Also it would be great if y’all could throw in more important information that I forgot to include. Thanks in advance !
PPOs
This type of insurance is better than HMO, but still not great. Your dental office negotiates with PPO insurance companies on fees for each treatment and when an agreement is reached you create a fee schedule. The fees in the fee schedule always pay you less money than you’d get doing the same procedure for a fee for service patient. At least with PPO you’re getting around 75% (or maybe more like 50%) of the full price you charge for the procedure, instead of basically nothing which is what you’d get from HMO. Patients with PPO insurance have to go to a dental office “in network” to enjoy their full benefits. This means an office that has agreed to honor the PPOs fee schedule. What if a PPO patient decides to go out of network? Will they still get PPO to help pay for the treatment or are they on their own?
The reason dentists accept these insurances is because it’s not a perfect world and you can’t expect to have a 100% FFS patient base. If you’re a Dentist with a new practice accepting HMO and PPO is a quick way to get a patient base. While your reimbursements are not good you’re better off doing work for less than full price than sitting on your thumbs all day and paying your staff by the hour for nothing.
This is just what I understand at this point. If someone with the knowledge I lack could answer my questions and correct all the incorrect points I’ve made I’d be very appreciative! Also it would be great if y’all could throw in more important information that I forgot to include. Thanks in advance !
