HMO vs PPO

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unlvdmd

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What is the difference in the dental field? How should we feel about each as dentists? I have minimal knowledge in this and I am very curious. Any webistes would be helpful in addition to ya'lls opinions. Thanks!

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Here's why dentistry is such a great profession: What's an HMO?
 
toofache32 said:
Here's why dentistry is such a great profession: What's an HMO?
Explain! PLEASE! I am seriously clueless....
 
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PPO stands for preferred provider organization. It is a list of private practitioners who have agreed to accept predesignated specific fees for specific procedures. This contract is arranged with the dentists by an insurance company. When a patient gets PPO dental insurance (usually as an employee benefit), the patient can choose any dentist he or she desires but will usually find that the dental benefits provided by the insurance plan will stretch farther if "preferred provider organization" dentists are used.

HMO stands for Health Maintenance Organization. HMO dentists work at HMO complexes and are paid a salary for their services. As a patient, if you have HMO insurance, your coverage is only good if you use HMO dentists. HMO's tend to offer patients a bargain on orthodontic work as a loss leader, but have a huge turn over in staff dentists and usually end up as sort of transition houses for newly minted DDS/DMD's.

In my Area, PPO's plans have not appeared yet. We have either Fee For Service or HMO plans. When employees are given a choice between Fee for Service and HMO dental insurance plans, they will usually choose Fee for service. Some will select HMO for a year or two in order to take advantage of the orthodontic bargains but will revert back to Fee For Service once the teeth are straight.
 
groundhog said:
PPO stands for preferred provider organization. It is a list of private practitioners who have agreed to accept predesignated specific fees for specific procedures. This contract is arranged with the dentists by an insurance company. When a patient gets PPO dental insurance (usually as an employee benefit), the patient can choose any dentist he or she desires but will usually find that the dental benefits provided by the insurance plan will stretch farther if "preferred provider organization" dentists are used.

HMO stands for Health Maintenance Organization. HMO dentists work at HMO complexes and are paid a salary for their services. As a patient, if you have HMO insurance, your coverage is only good if you use HMO dentists. HMO's tend to offer patients a bargain on orthodontic work as a loss leader, but have a huge turn over in staff dentists and usually end up as sort of transition houses for newly minted DDS/DMD's.

In my Area, PPO's plans have not appeared yet. We have either Fee For Service or HMO plans. When employees are given a choice between Fee for Service and HMO dental insurance plans, they will usually choose Fee for service. Some will select HMO for a year or two in order to take advantage of the orthodontic bargains but will revert back to Fee For Service once the teeth are straight.

The compensation models of PPO vs HMO are very different.

Often the HMO's are capitated plans where the dentist is paid by the head (cap - caput = head in Latin). The dentist may receive a few dollars per month per person.

Whereas, the PPO model the dentist is paid by the procedure just like Fee for Service but at a reduced contract negotiated rate - usually 25-30% lower than UCR fees.

There are other differences but will comment later and find some links for everyone ( if you are interested).
 
Fullosseousflap said:
There are other differences but will comment later and find some links for everyone ( if you are interested).
I would love the links. Thanks so much for your replies.
 
unlvdmd said:
I would love the links. Thanks so much for your replies.

Here is a link that talks about the evolution of managed care.

Click here
 
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