HMOs

[busupshot83]

How did HMOs form? And how did they get such a tight grasp over the medical field? What can future dentists do (if anything) to ensure that HMOs don't take over our field?

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[aphistis]

Originally posted by busupshot83
What can future dentists do (if anything) to ensure that HMOs don't take over our field?

We can refuse to participate.

 

[gryffindor]

1. Join the ADA.

2. Just say no.

 

[organic]

definitely say NO to HMO!

 

[trypmo]

I'd feel guilty not accepting insurance because there are so many people I wouldn't be able to treat, unless they were willing to pay out-of-pocket, which doesn't seem fair to them, so I'd probably absorb the cost of a lot of the procedures out of sympathy and then not be able to pay back my loans! Argh! Either that or become heartless.

Does dental insurance exist that is non-HMO? I've always been a bit fuzzy on this. In the above statement, I've assumed not.

And what's the deal with HMO vs. PPO? Are they both equally evil?

 

[DrJeff]

Originally posted by trypmo
I'd feel guilty not accepting insurance because there are so many people I wouldn't be able to treat, unless they were willing to pay out-of-pocket, which doesn't seem fair to them, so I'd probably absorb the cost of a lot of the procedures out of sympathy and then not be able to pay back my loans! Argh! Either that or become heartless.

Does dental insurance exist that is non-HMO? I've always been a bit fuzzy on this. In the above statement, I've assumed not.

Most dental insurance nowadays is non HMO, plain and simple, the dental industry has seen what's happened to our medical colleagues and doesn't want it to happen to us. As was already posted, if you don't sign up for it, it won't happen!

And what's the deal with HMO vs. PPO? Are they both equally evil?

HMO's are the worst of the worst. basically if you sign up, your then asigned a pool of patients for which your paid a set small fee per month to cover all of those patients needed dental care. You basically end up hoping that all the patients asigned to you DON'T show up for care, since if they all did, you'd be operating a loss.

PPO's are better. You enroll in a PPO and agree to accept a fee schedule determined by the insurance company for each procedure(generally between 70-90% of what your regular fee schedule is). You can't bill the patient the diffrence between what your fees are and what the insurance companies limits are (I.E. if your fee for a crown is $800 and the PPO fee shedule fee is capped at $700, you submit to the insurance company for the $700, the insurance company writes you a check for $560 since they only typically cover 80% of their fee limits, and then you bill the patient for the $140 to = the $700 total fee. The remaining $100 that you'd normally charge gets written off from your production during office accounting). The "advantage" as the insurance company markets it, is that they'll list you in their book and "market" you to their enrolled members.

You don't have to be a participating provider of an insurance company to have your patients get their dental benefits from essentailly all non HMO dental plans. My partner and I are only particpating providers with Anthem Blue Cross/Blue Sheild and Delta Dental, but we have hundreds of patients that have insurances like Aetna, Cigna, Met-life, Aflac, etc. The difference is that with those patients, when we submit to the patients ins. companies, we get the UCR(usual, customary and reasonable) fees for the area, but then we can bill the patient for the total remaining balance, not just the remaining balance upto the insurance pre-determined fee for that procedure. If you're a provider with an insurance company, you're required by contract to write off the difference between your actual fees and the insurance companies pre-set limits (last yeat my office wrote off over $50,000 in those fee differentials

That then brings up the philosophical debate about why a $500 dollar fee for 1 patient can only be a $450 dollar fee for another, even though they're getting the same materials, the same level of treatment, the same doctor doing the treatment, all because that person has a specific insurance card in their pocket?? (See my thead on "why I dislike insurance companies for further elaboration)

 

[organic]

my friend ( NOT accepting any HMO) has patients who are insured by HMO but still come to see her for treatment and pay out of their own pocket totally. One patient told my friend that her HMO dentist estimated 5000 dollars of charge for full-mouth cleaning!