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my physiology professor quit dentistry because of HMO.
why is HMO that bad?
why is HMO that bad?
what is wrong with HMO?
- Thread starter issa
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They pay you anywhere from $5-35 bucks for a prophy, which is insulting. My manicurist friend down the road who just came to America last month and speaks no English and have zero debt and no expense makes more than that on 10 fingernails in 15 minutes.
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they don't even pay you that much.
so the way that hmo's work is that you have a roster. let's say you get 5 bucks per person on your roster each month, whether they come or not. if you have 10 patients, you receive 50 bucks each month, guarteed whether you see the patients or not. where this backfires is if all your patients come in that month multiple times for a routine check (which hmo's dont pay extra for), then you've worked far more than you're getting paid...almost like working for free. there are very few procedures where you get a supplementary payment from the insurance (such as a crown) if you do the work and the copays are minimal for many hmo plans. so basically, it comes down to you doing free work. plus how long all the it takes to get work approved is such a pain. and your patients think that their hmo covers everything, so when they ask for posterior composite fillings, and you tell them that they aren't covered, and they have to shell out a little cash, they make quite a fit.
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That's why most private practices are cash/check/charge now. Dental insurance is pretty crappy.
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Once upon a time, in a galaxy far, far away, HMO's were pretty good, at least for patients. Since then the bean counters and lawyers have eliminated all concern for anything but the bottom line, screwing both the patient and the doctor and turning health care in the US to the biggest joke of the developed world.
Has anyone noticed that the quality of candidates, quality of health care, and quality of education in the US have all nose-dived simultaneously?
RP
Has anyone noticed that the quality of candidates, quality of health care, and quality of education in the US have all nose-dived simultaneously?
RP
J
jackbauer!
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There is nothing wrong with a HMO. You are born one and its not a choice. Quit making fun of people. Thats wrong. My bestfriend is part of a group of HMO's at his school and he is happy.
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I cant beleive your physiology professor is so shallow. Quit dentistry because of a HMO? Come on. Its 2007 and we still have people like this in society. That is so wrong to single out a group just because they are part of a HMO group.👎
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Seriously, you can't just go picking on people because of their "orientation."
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New York City will start paying $100 to each family member of a "poor family" who sees the dentist every six months! Meanwhile DMO is paying dentist a lousy $5 buck per person. I always wonder why any rational dentist would take such a plan.
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That's ridiculous if it's true. They'd be paying the patients more than the doctor!
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Their is some sense in this though as weird as it sounds. If the costs to the city interms of ER visits and missed school days/work days is greater than a $100 pay out for routine care (which would be covered under the premiums that the city is paying for their HMO dental insurance) then it would be somehat valid. A bit crazy sounding, yes, but definately plausible.
One of the biggest dental insurance issues out there, especially for the underserved as our "smart" politcians try and figure soemthing out
, is that they want to fund a plan for everyone that ensures everyone gets "cadillac" care. The reality is, not everyone wants to goto the dentist, nor should everyone get "cadillac" care out right. Lets be honest, the person with a horrendous diet and lack of oral hygiene care over years and years and years shouldn't just simply be entitled to full mouth reconstruction with multiple endos/crowns on a state/federally funded dental plans "just because". That makes absolutely no sense, and unfortunately politicians don't get this. They just seem to think that the more $$ you through at a problem the quicker it will fix itself🙄😡
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So the city pays the dentist $5 and the dentist charges the patient the usual and customary fee (or maybe a discounted fee) for cleaning/filling. That's what the $100 is for.
RP
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What is an HMO? A bunch of people pool their money to pay healthcare providers specific fees for services. Unfortunately, bigger and bigger chunks of that money are going to lobbyists, accountants, and CEOs, all of whose jobs are to ensure that minimal money actually goes out for healthcare by ensuring that minimal healthcare actually gets delivered.
So what is a socialized health care system? The government collects taxes and pays fixed fees to healthcare providers to provide health care.
Are there problems? Sure. Who is going to see that the sort of rampant fraud that exists in Medicaid/medicare doesn't take over a bigger, "socialized" system? You're going to need many thousands of new government employees to oversee the movement of the money. That's life. What's worse- paying people to make sure the money is spent on health care or paying lawyers/CEOs/accountants to make sure that the money ISN'T spent on health care?
Maybe you're worried fees will drop if the government becomes the main payer. Don't worry, there are plenty of cosmetic procedures that your more well-heeled clients will still pay for. You can always opt out of the system and take only cash for your services as many have done.
RP
PS - the label "socialized" is used by "conservatives" to try to generate an emotional reaction. They are the people who benefit most from the situation remaining as it is.
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Actually, if you are on an HMO program, you get the five dollars and you can't charge the patient more money for the prophy...it think that's the whole point of being on an HMO.
I'm on a PPO. I go to a dentist who is part of the PPO network for a cleaning. The dentist usually charges $100 for the cleaning to people without any insurance, but the PPO only pays $60 as part of the PPO agreement the dentist agreed to to be on the PPO network and get PPO referrals. The dentist can't charge me the other $40 because getting paid only $60 was part of the agreement he or she signed.
I'm pretty sure HMO's are similar in that way. If you only get $5 for each patient and the patient shows up for a routine exam that month...you have to see the patient because you're part of the HMO agreement and you can't charge them extra now that they are there. That's why it can be hard to make enough $ to even break even if you accept HMOs
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dead on with both. ppo plans are better though bc there's usually a deductable that the patients pay, as well as the insurance only cover a percentage of the procedure. For example, most PPO companies cover about 80% of the fee for minor restorative procedures, such as a filling. If the filling cost about 100 bucks, you get 80 + the deductable and you're suppose to charge the patient the remaining 20%. however, with most hmo's, you'd only get that 5 bucks per month per patient, and you wouldnt get get a supplementary payment for that filling. even though some hmo's have copays for fillings, it's like another 10 bucks, and most hmo's don't have anything as the copay. so basically, you're making 15 bucks on that appointment, which barely covers 1 assistant working for you for an hour. not to mention, the cost of supplies (even amalgam is really expensive), so you're in the red. hmo's are robbing dentists.
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The benefit for working at a DMO is that you are salaried. For example, Willamette Dental will salary a fresh grad at 85k/year plus full benefits (med/dent/pharm/retirement/ 2weeks paid vacation). If you produce enough you earn bonuses. The salary and benefits are locked...it is sort of a conservative step for new dentists who need a solid income immediately, but wont earn more in the long run.
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ya, it's definitely more stable in terms of a month to month income...but you can never break through to make more money. it's for some dentists and not for others. i spent 4 years working with hmo's, and some of them made my life miserable (and i wasn't even the dentist!) and it was then that i promised myself to never work with them again. i don't mind insurance, ppo's are fine. even medicaid treats you better than hmo companies!
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I think there is more to it than that. If no doctor or dentist could make money if there was an HMO or PPO paying the bill, none would accept HMO/PPO patients. Doctors and dentists are generally not stupid people and someone who accepts a losing deal would have to be pretty stupid.
RP
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:cry:I think their are a lot of dentists, especially those who graduated in the 60's, 70's and even the 80's who can accept HMO's and PPO's and make some profit, albeit a much smaller one than if they did not participate.
In 1970, tuition and general fees alone at University of Pennsylvania Dental School, a private dental school, were only approximately $2,500, in 1980 about $10,000 and today they are over $53,000 and this figure does not include the ever increasing costs of books, dental equipment and supplies or technology fees. Start up costs for opening a dental practice were also considerably lower, and banks viewed dental practices as more of a sure thing. I read a recent dental economic article that stated that banks/lending instutitions often cap new dentist start up loans at about $450,000. While that seems like a lot of money, starting up a business from top to bottom is very expensive and that is not including the purchase of any real estate.
New dentists with a lot of school debt and high office overhead who accept HMO's and PPO's may stand to be the biggest losers. With the combination of high overhead and high dental school debt, they may not be in a position to profit while accepting HMO's and PPO's.
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Quite true ... and also quite sad that dentistry seems to be following the footsteps of medicine!
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Then if they are smart, they won't accept HMO/PPO patients. If those are all there are in their chosen location, they chose the wrong location.
RP
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Actually, many insurance companies have been unsuccessful with roll-outs of DMO's. Quite simply because a majority of dentists refuse to sign up for them, so when a company subscribes to a DMO and their employees can't find an enrolled dentist within reasonable driving distance, their human resources dept hears all the griping and the company is very often either dropping dental insurance or upgrading to a PPO. And as the insurance companies are seeing poor dentist enrollment coupled with high subscriber complaint rates, they're dropping them.
Fortunately in the big scheme of things for dentistry, while a significant piece of the healthcare equation, were still small enough to "fly under the radar" of widescale governmental involvement, and having scene what has happedn to our medical colleagues with the HMO'ing of medicine, as a whole dentistry is doing nicely at avoiding it👍
To digress slightly, this DMO/insurance/dentist insurance plan participation concept is one bigtime example of why folks should join/remain members of organized dentistry (ADA, etc). One of the big things that the ADA and its state societies work for is both fair trade with the insurance companies, AND the autonomy for you as a dentist to pick and choose what plans you'd like to enroll with, not just mandatory participation with all their plans. This very work by organized dentistry to prevent you from having to enroll with DMO's if you so choose, will make you literally hundreds of times over each year what your ADA dues are!
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What is an HMO? Health Maintenance organizations was a failed attempt to curb medical inflation which, has been twice the rate of the consumer price index over the last 25 years. We all know that it gives insufficient captitation compensation and copayments which will make go broke for providing the services. It did make a differerence to patients and employers for about 10 years but to much of a price to the providers accepting it. The basic idea has merit but it goes to far. I understand both sides of the equation, providers want to do the best and do all of it now, patients want to keep their teeth and be able to pay their rent. We as a profession have to come up with a middle ground that works. We can not expect that all will invest in the dental equilvent of a BMW when most of the population can only afford a corolla that keeps them going and is reliable.
No one wants socialized medicine but ignoring the affordability of medicine and dentistry is considered out of control by most out of the field creates more lobbyists and government regulations than most anything else in the present economy. If the professions want to keep their peice of the pie and don't find something that will work for both the publics and healthcare welfare, or history will repeat itself as other developed countries, the socialized medicine model will repeat itself. We can't keep on thinking people will fix their teeth to eat well and look better when the average person can not pay for food and a haircut and making them make this choice. If we don't think of something, the government will make changes, and no one will be happy.
Personally, I think I have a solution that works for both sides, actually making greater incomes for dentistry, but most have your atitude. It is time for a change.
This is very true. A certain percentage of the population will always be able to afford dental care, but for many, possibly more in the future, without an HMO or PPO's, dentistry is already unaffordable. Dentists that participate with these plans are often just meeting their overhead. Their profit is not at their HMO and PPO patients expense, it comes from their regular insurance or cash patients. However, the insurance companies do not seem to be losing any money, ever, not even on their HMO's or PPO's plans.
The cost of college and a dental education, the unpaid years obtaining the education and the cost of running a business ultimately should dictate pricing, not insurance companies. They are winning either way. I don't think it's physicians or dentists who are the culprits in escalating costs. When we first started our practice 23 years ago the cost of a crown was between $450 - 500. Today it's close to $1,000. So, in 23 years, the cost of a crown has approximately doubled. I think that's about a 3 percent or less rate of inflation in the cost of a crown, certainly not double the rate of inflation in the general market place. Yet all of my costs have more than doubled during this time, staffing, equipment, supplies, etc. If I were to accept an HMO/PPO I would have to accept between $600-700/crown, barely 20% more than I was charging 23 years ago! So, something gives, you decide.
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so what's your solution? bc it is becoming a huge problem...dentists need to pay their debt, but it's not fair for patients to pay an arm and a leg for their care either. afterall, dentistry is a service, and healthcare should be a priority. but it's difficult when a dentist also has to provide for his/her family as well.
it really is true, the insurance companies are robbing all of us...the patients and the dentists. i feel like the hmo's make life more difficult for the patients and the dentists alike. as i said, dentistry should be about healthcare, and providing adequate care for your patients, but we need to survive as well. most dentists here are dropping their hmo patients bc of the difficulties associated with hmo's, but how are the patients suppose to receive dental care in that case? we really are caught in the middle, and i hope there is a better solution in the near future.
We've got to find a middle ground, but maybe it's by not having a third party, for-profit, ie insurance companies, in the middle.
As any dentist with a small business knows, we are all paying an arm and a leg for medical insurance and because we are small businesses, we pay a lot more and get less, higher rx and doctor visit co-pays. My biggest concern is what if anyone, dentists included, becomes disabled how is he or she going to afford health insurance. Many insurance companies are dropping members after health problems, ie cancer or other medical problems.
There has to be a solution, but it won't be a for-profit solution. This is going to be an expense, but it's a necessary one. If everyone feels like they would benefit, as in Massachusetts plan, maybe it will be easier for everyone to be on board. We need a solution. I hope we're on our way to getting an expedient and helpful one. We need it.
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In order to understand what is going on with medicine and dentistry with regrads to insurance, you have you understand the fundamentals of the insurance business. Here's a brief overview:
The goal is to make money, as much as possible. How is this achieved? Collect a lot from the people you insure, then pay out as little as possible, none if you can get away with it. The people in the insurance business are as passionate about making money as you are about taking care of other people.
That's it. Lesson complete.
This is why insured people hate their insurance companies. It is also why doctors and dentists hate insurance companies. They are out to screw everyone. By its nature, health insurance guarantees that minimal health care will be delivered. The less it delivers, the bigger the CEO's bonus will be.
That is why insurance company's phones are manned by idiots who know absolutely nothing. If you are calling the insurance company, you are probably trying to get them to pay for something. By throwing endless bizarre phone answering system loops and idiotic people on the lines they know that they can get 99% of people to give up in frustration. Since all insurance companies provide the same level of nonservice, they know you aren't going to go to some other company.
Private insurance is NOT the way to pay for anyone's healthcare. It doesn't work. Insurance companies are the enemy. Never forget it.
RP
The goal is to make money, as much as possible. How is this achieved? Collect a lot from the people you insure, then pay out as little as possible, none if you can get away with it. The people in the insurance business are as passionate about making money as you are about taking care of other people.
That's it. Lesson complete.
This is why insured people hate their insurance companies. It is also why doctors and dentists hate insurance companies. They are out to screw everyone. By its nature, health insurance guarantees that minimal health care will be delivered. The less it delivers, the bigger the CEO's bonus will be.
That is why insurance company's phones are manned by idiots who know absolutely nothing. If you are calling the insurance company, you are probably trying to get them to pay for something. By throwing endless bizarre phone answering system loops and idiotic people on the lines they know that they can get 99% of people to give up in frustration. Since all insurance companies provide the same level of nonservice, they know you aren't going to go to some other company.
Private insurance is NOT the way to pay for anyone's healthcare. It doesn't work. Insurance companies are the enemy. Never forget it.
RP
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big business at its finest.
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When's the last time you heard an insurance company post a quarterly loss??? Sure, every now and then PROFITS won't meet expectations, but them posting a loss, not so.
If it wasn't for some of the profits that oil companies are making now, you'd hear alot more insurance company profit flack, since the biggies are turning quarterly profits in the BILLIONS of dollars.
Actually, health care heavy insurance companies are great if their stocks are in your investment portfolio😉
If it wasn't for some of the profits that oil companies are making now, you'd hear alot more insurance company profit flack, since the biggies are turning quarterly profits in the BILLIONS of dollars.
Actually, health care heavy insurance companies are great if their stocks are in your investment portfolio😉
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The solution is an E.P.O. OR exclusive provider organization, if you look at the numbers you will be able to see that simply ( and this has taken a long time to figure out) if the provider gets the premium, he can charge rates that are basically done 20 years ago. We are not in the middle. we are the solution
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Dentistry as of 2004 is a 1.55 trillion dollar industry with 73 billion dollars paid in fees including insurance payments and government programs so Where did the rest of the money go ??? Insurance income is not measured in billions anymore, but in fractions of trillions. You previously asked what the solution was. I would attached this letter but I guess it is blocked to make sure no ads are put in this forum, so I will quote it. It it an example of how successful so dentists are incorporating refferral plans into their practice.
" Dear Dr. Weinstein;
I am a single parent with two children and needed a dental plan that fit my budget.
For years, we belonged to Delta Dental through the military. We paid a monthly premium and we also had to pay co-payments.
Since we have moved to Florida. My parents recommended who offered an "in-house" dental insurance plan of his own. We know a lot of people who use this dentist and are equally satified not only with the quality of his work, but how reasonable his plan is.
For one yearly payment, my family gets a dentist we can trust, an excellent office staff and a plan we can afford. We get a complete set of X-rays, two office visits per year and best of all two cleanings per year.
We have been lucky not to need extensive dental work but my younger son was told to brush better or he would develop gingivitis.
They took the time to show him how to brush more carefully, how to maintain his teeth and gums and gave him a routine to follow at no extra cost.
In short I am very pleased with my dental and have renewed it for a second year. Surprisingly the rates didn't go up.
I looked at other plans and just like my parents, highly recomment this one.
Thaks for all your time;
Sharon Mcsweeney"
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Presently it is estimated that about 50 % of the population have dental insurance, it is probably more accurate that 50 % of the population have access to some type of dental coverage. Location is important, but we all can not practice in Beverly Hills or it's equilivent. Today more practicioners are not accepting HMO/PPO but more and more companies are offering them to their employees if they offer anything.
It would nice to think you can pick the market you want to treat, but most like to make an effort to expand their markets, not decrease them. I am sure that not wanting to accept HMO/PPO is something most providers will do. But rejecting 1 out of 2 of the peolple who seek care is not a realistic solution.
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I ilike the idea of the patients paying a fixed fee to the dentist for annual services. It helps maintain some patient "loyalty" since they have paid the fees they aren't inclined to go elsewhere, and they know they'll get good care without being hit with huge bills. I especially like it because it cuts out the insurance companies who don't seem to add any value to the process for anyone but themselves.
RP
RP
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Insurance although a very lucrative business is based on risk vs. reward or risk assessment and besides it is what people want. The problem with dental insurance is the risk is to great, if you buy life insurance, you hope in every way it is not something you will ever use. Dental is not that way, when most get it, they have made up their minds they will use it, it is just a bad bet for the insurance company, that is why it costs so much for to little benefits.
You have a point insurance companies are not your friend, but the only way to beat them is to join them, in other words, incorporate a referral plan into your practice
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It is if you're going to lose money.
The insurance companies try to force down rates. If they force prices so low that the only guys who can make a living treating insured patients are the guys who cut corners everywhere and do sloppy work (recycling water in the spit sink?), then who is benefiting? The patient gets crap work done, the dentist can't cover expenses, but the insurance company always seems to come out OK. Hmmmm.
If you want to do charitable work and treat people who can't afford dental care, then do it. But treating insured people and losing money is pointless. All you're doing is buying a bigger boat for the CEO of the insurance company.
In almost any location there are small businesses that can't afford to provide dental insurance for employees. What if you approached the owner and said you'd work special rates for employees of that company if the employer sends them your way without insurance? Employer is happy because he has a "dental plan" to offer employees. Employees are happy because they get reduced rates and quality care without having to deal with insurance. Dentist is happy because he gets patients that pay reasonable rates without having to deal with insurance companies.
As an engineer I worked for some of the biggest tech companies on earth. They all offered some health and dental coverage, and they were ALL crap. I dreaded dealing with insurance paperwork more than income taxes (except when I worked in Japan where they have "socialized" healthcare- there was no paperwork, but care provided was terrible). I am healthy and rarely had cause to use any of the insurances. I can't imagine the hell that someone with diabetes or other chronic illness has to go through.
RP
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Your first idea sounds logical, but I have never heard it discussed or even mentioned in any dental practice management lectures/books. The only time I recall reading about a similar setup was with a group of OB physicians who were so tired of doing ins. co. paperwork for some plan offered by the big employer in town, that they just went to the employer and set up a similar deal for pregnant employees and both parties were very happy with the outcome.
Anyone have more info on this?
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they do a similar set up in the vet business. clients can purchase a yearly plan for their pets from the vet that covers check up and vaccines and stuff, obviously without dealing with insurance. keeps both clients and vets happy
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yeaaa i work in a dental office and HMO is never good - like everyone else says they pay basically nothing - if anything...
our Drs are considered "in-network" w/Horizon....but if the patient has Horizon-HMO then they can't even come to our office! Human Resources or whomever deals with the employer and their insurance names a SPECIFIC dentist in which they can go to where they will actually get paid - no where else..
so basically any dr that doesn't participate w/HMO is screwed!!
our Drs are considered "in-network" w/Horizon....but if the patient has Horizon-HMO then they can't even come to our office! Human Resources or whomever deals with the employer and their insurance names a SPECIFIC dentist in which they can go to where they will actually get paid - no where else..
so basically any dr that doesn't participate w/HMO is screwed!!
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Optometrists do it to, there is a lot of stuff right know on something similar but it a very for high profit plan to qualify only for the elite called "MDVIP", a concierge medical plan. You might want to google that.The idea is similar, a qualfying fee for access with "wellness" services and the MD limits his practice supposedly to give VIP service to the patient members, but my numbers are quite different, my plan is meant for the middle class to create better access, not limited access, taking insurance actuarial tables into account. Basically I have been putting this together for quite a while. Basically the numbers are pretty amazing, sometimes I don't believe them, putting it all together, you can charge 1/2 the normal dental fees and make twice the income. If you find that hard to beleive, I don't blame you, but I have checked it many times and it always come out the same.
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DDSwithAplan, I've heard of MDVIP, but that's not the same as you were suggesting which is to hook up with a small business owner and offer dental services to his employees via an "in-office plan" eliminating the insurance industry's dental plans altogether for that company. MDVIP means that the (usually wealthy) patient is free to choose which MDVIP clinic he wants to pay to "join." Your idea means that the patient is coming to you mostly because his employer has an arrangement worked out with you. I think it makes sense as a way to cut out the insurance middleman, but that's why I'm saying that I wonder why I don't hear about it more often. Is there some sort of legal barrier to doing it? Or maybe it's just a good idea and has yet to catch on, kinda like the MDVIP idea.
I think many patients have been conditioned to think that unless they have "insurance" they can't step foot into a dental/medical/optometry office. I regularly come across educated people with really good jobs and salaries who complain about "Oh I don't have dental" or some other insurance gripe, and they look at me like I'm an idiot when I say "You can go to a dental office and pay for it yourself, it's not that unaffordable." It would be great to eliminate dental insurance all together, but that might leave these conditioned patients to think that now they have no options to go the dentist/optometrist. Your idea still gives them that comfort level of "Oh I have insurance!" but just makes it a better deal for you and the other business owner.
I think many patients have been conditioned to think that unless they have "insurance" they can't step foot into a dental/medical/optometry office. I regularly come across educated people with really good jobs and salaries who complain about "Oh I don't have dental" or some other insurance gripe, and they look at me like I'm an idiot when I say "You can go to a dental office and pay for it yourself, it's not that unaffordable." It would be great to eliminate dental insurance all together, but that might leave these conditioned patients to think that now they have no options to go the dentist/optometrist. Your idea still gives them that comfort level of "Oh I have insurance!" but just makes it a better deal for you and the other business owner.
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👍You are correct gryffindor, "MDVIP" is different but the principles have similarities, a qualifying fee that protects and insures the doctors that he is dealing with someone who is serious about receiving care and grants them access, only the numbers are different to work with a different sector of the population. As far as working with a small business owner, your idea has merit except businesses are cutting benefits not adding them, if they going to give their employees anything, they will partially pay for major medical coverage with making the employee have a major payroll deduction, dental is at the bottom of the list for most. People do beleive that if they don't have insurance they will not go. There is an article from Delta Dental, " Access is still a Priority", that people with any plan as twice as likely or better to go to a dentist with any plan, this looks like a duck, walks like a duck, talks like a duck, but it is not a duck, it is a marketing tool that helps both patient and provider, and cut out the hassles of insurance. As any marketing tool, you now can market better to anyone, if small business is your target, it might help, but don't forget the other 50% of the population who want some type of coverage and have no access to it, it works for them to, actually better for the provider, in, A Study of "Broken Appointment" Patients in a Children's Hospital Dental Clinic by ROBERT CHARLES FAZIO and JOSEPH BOFFA, Patients are twice as likely to break or "no show" for their appointments with dental coverage, insurance studies show that 60 % of people with dental coverage will use it, 40 % won't, even wit a reasonable member fee and greater access, you always win
