What is the difference between HMO and PPO dental plans?

by Dentistry21 Editorial Team

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What is the difference between HMO and PPO dental plans?
If your employer offers dental benefit or if you are shopping for it yourself you often come across two terms:
1. Dental HMO plans (DMO)
2. Dental PPO plans
To be able to make a correct decision you should know the difference between the two, and I don't mean the coverage difference that is usually presented by the insurance companies. What I mean is the real difference.
You should know how they pay the doctors and which plans the doctors favor. Why? Because eventually it is the dentist that will provide the service to you and not the insurance company. So, no matter what the insurance company claims their doctors have to do, your dentist will treat you as he or she sees fit.
To look at the issue from the perspective of a dentist, let's see how they differ in terms of payments to the doctors.
1. The PPO plans
PPO plans, also called preferred provider plans, pay doctors based on the procedures they perform. In other words, for each approved treatment or service performed by your dentist the insurance company sends him a payment (assuming other limitations don't apply). When you are talking about this kind of coverage, it means the more your doctor does the more he is paid. Of course there are checks and balances in place to make sure the doctors overall performance is acceptable.
2. HMO plans
When it comes to a general dentist, usually the way the insurance companies pay is called capitation payment. Which means they sign a contract with a doctor for a certain number of people (let's say 500 people). Then they pay doctors a monthly payment for each patient (Something around 1-6 dollars per person). Then in return they expect the dentists to perform certain procedures for free and some others at a discounted rate.
When you think about it, you realize practically they reward doctors who do less! As far as the dentists are concerned if they are performing a "covered benefit" they are losing money! The only time they make money is when they perform a procedure that is not covered by insurance.
Getting more familiar with the system, you now realize why some dental offices act strongly when you call them for appointments having an HMO plan.
The fact is that insurance companies (being a large monopoly dealing with a non-union crowd) have pressured many doctors (both in medicine and dentistry) to sing up with HMO plans. That has resulted in lowering of the quality of service across the country.
Next time you are thinking about selecting an insurance plan keep in mind the way they reimburse the doctors. You should not make your decision only based on the list of co-pays they give you. You may end up paying much more for a lower quality of service in the long run.
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