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HMO Plans
HMO insurance is actually a misnomer. It's not an insurance plan, it's more like a discount membership plan. HMO "insurance" plans don't pay dentists for treatment. They simply mandate a lowered fee that the patient pays.
This is a huge cost-saver to insurance companies because their pay-out is tremendously reduced when compared to PPO plans and especially indemnity plans. Basically, instead of the patient and insurance company splitting the bill, it is now the dentist and the patient splitting the bill. The result is that much or most treatment is performed at a loss to dentists.
Here's how it works:
The HMO company subscribes a group of patients and contracts with a few dentists. They require that every patient member select a single dentist or dental office from their list who will be responsible for their health maintenance. The HMO company pays the office a small amount per month, usually between $1 and $3, for each patient who selected that office. That payment is made regardless of whether the patient made a visit to the office that month or not.
For example, let's say an HMO company has 1,000 patient subscribers. Out of those 1,000 patients, 300 chose office A, 300 chose office B, and 400 chose office C when they signed up for their HMO plan. At $2 per patient, office A gets $600 per month, office B gets $600 per month, and office C gets $800 per month. This is called a capitation fee, it's like a membership fee the dentist gets every month for patients that chose that office on their plan.
Out of the 300 patients that chose office A, let's say 60 decided to visit the dentist during the month. For those 60 patients, the dental office is required to provide many services such as examinations, x-rays, cleanings, and silver fillings at NO COST. The patient does not pay for these services, nor does the HMO company. The $600 monthly capitation fee is meant to cover the dentist's costs for those free services. Whether it actually does is another story.
When it comes to major treatment, like crowns, bridges, and dentures, the patient pays a highly discounted fee. The HMO company pays nothing. It's the dentist that pays the majority of the bill. Because of this, the lowest quality treatment option is the one that's covered.
For example, if a patient needs a crown that normally costs $800, their fee might be $200 under the HMO plan. But for that fee they can only receive a stainless steel crown, not a porcelain crown. They must pay for upgrades if they want a higher quality crown, with gold, or porcelain, or cosmetic edges.
Let's say the total fee with porcelain comes to $350. For a dentist to do an $800 crown for $350 and not go bankrupt requires special skills and talent. Furthermore, if a dentist or dental office has not developed a moral and ethical way to cut costs and deliver $800 crowns for $350 and stay in business, then they have no motivation to diagnose and perform treatment.
Remember that Glendale Dental Arts, and John Gazarian, DDS, have been a dental landmark in the city for over 25 years. In our office we've seen the results of the changing trends in dentistry and the impact dental insurance has had on the quality of dentistry throughout the surrounding communities.
More and more, patients come to our office with deteriorating dental health, having received inadequate dental treatment from dentists attempting to treat a tooth for less than half the price that's needed. As a result, much of the dentistry we perform is reparative dentistry, fixing problems created by prior dental work.
In the 70's and early 80's, indemnity insurance plans provided access to high quality dentistry to many people. But as trends changed, and HMO companies took over the market share, the quality of dental treatment has declined. Since HMO plans don't pay for treatment, patients are often surprised at their bills, even if it's only $350 for an 800 dollar crown.
Combine that with the fact that you can find a dental office on every corner, near liquor stores and 99 cent stores, the perceived value of dentistry has declined over the past 15 years tremendously. In the past, people had budgets for medical and dental costs. Now, that money is spent on electronics, and few people ever think it's necessary to save up for something they can get next door to a 99 cent store.
The HMO companies are happiest when they have the most subscribers. And in general, patients are happiest when they are paying the lowest fees for what they think is dental insurance. This is sad, because the results are a steadily decreasing level of dental health for everyone.
As we work to reverse the trend of low quality dentistry, we need your help. As a well-read patient, we ask that you help spread the word. First, understand how important it is to choose your dentist and dental insurance carefully. Then help others respect and understand the current state of dentistry as much as we and you.
This is a huge cost-saver to insurance companies because their pay-out is tremendously reduced when compared to PPO plans and especially indemnity plans. Basically, instead of the patient and insurance company splitting the bill, it is now the dentist and the patient splitting the bill. The result is that much or most treatment is performed at a loss to dentists.
Here's how it works:
The HMO company subscribes a group of patients and contracts with a few dentists. They require that every patient member select a single dentist or dental office from their list who will be responsible for their health maintenance. The HMO company pays the office a small amount per month, usually between $1 and $3, for each patient who selected that office. That payment is made regardless of whether the patient made a visit to the office that month or not.
For example, let's say an HMO company has 1,000 patient subscribers. Out of those 1,000 patients, 300 chose office A, 300 chose office B, and 400 chose office C when they signed up for their HMO plan. At $2 per patient, office A gets $600 per month, office B gets $600 per month, and office C gets $800 per month. This is called a capitation fee, it's like a membership fee the dentist gets every month for patients that chose that office on their plan.
Out of the 300 patients that chose office A, let's say 60 decided to visit the dentist during the month. For those 60 patients, the dental office is required to provide many services such as examinations, x-rays, cleanings, and silver fillings at NO COST. The patient does not pay for these services, nor does the HMO company. The $600 monthly capitation fee is meant to cover the dentist's costs for those free services. Whether it actually does is another story.
When it comes to major treatment, like crowns, bridges, and dentures, the patient pays a highly discounted fee. The HMO company pays nothing. It's the dentist that pays the majority of the bill. Because of this, the lowest quality treatment option is the one that's covered.
For example, if a patient needs a crown that normally costs $800, their fee might be $200 under the HMO plan. But for that fee they can only receive a stainless steel crown, not a porcelain crown. They must pay for upgrades if they want a higher quality crown, with gold, or porcelain, or cosmetic edges.
Let's say the total fee with porcelain comes to $350. For a dentist to do an $800 crown for $350 and not go bankrupt requires special skills and talent. Furthermore, if a dentist or dental office has not developed a moral and ethical way to cut costs and deliver $800 crowns for $350 and stay in business, then they have no motivation to diagnose and perform treatment.
Remember that Glendale Dental Arts, and John Gazarian, DDS, have been a dental landmark in the city for over 25 years. In our office we've seen the results of the changing trends in dentistry and the impact dental insurance has had on the quality of dentistry throughout the surrounding communities.
More and more, patients come to our office with deteriorating dental health, having received inadequate dental treatment from dentists attempting to treat a tooth for less than half the price that's needed. As a result, much of the dentistry we perform is reparative dentistry, fixing problems created by prior dental work.
In the 70's and early 80's, indemnity insurance plans provided access to high quality dentistry to many people. But as trends changed, and HMO companies took over the market share, the quality of dental treatment has declined. Since HMO plans don't pay for treatment, patients are often surprised at their bills, even if it's only $350 for an 800 dollar crown.
Combine that with the fact that you can find a dental office on every corner, near liquor stores and 99 cent stores, the perceived value of dentistry has declined over the past 15 years tremendously. In the past, people had budgets for medical and dental costs. Now, that money is spent on electronics, and few people ever think it's necessary to save up for something they can get next door to a 99 cent store.
The HMO companies are happiest when they have the most subscribers. And in general, patients are happiest when they are paying the lowest fees for what they think is dental insurance. This is sad, because the results are a steadily decreasing level of dental health for everyone.
As we work to reverse the trend of low quality dentistry, we need your help. As a well-read patient, we ask that you help spread the word. First, understand how important it is to choose your dentist and dental insurance carefully. Then help others respect and understand the current state of dentistry as much as we and you.
