New Page 1

Do I have Dental Insurance....or a Dental "Plan"?

We hear this question quite often. Since this has become such a confusing issue, and since we rarely find patients who understand what they have in the way of coverage...we'd like to see if we can clarify some of this confusion.

Healthcare in America has undergone quite a change in the past few years. An alphabet soup of letters have become recognizable by everyone; HMO’s, PPO’s, DMO’s, to name a few. Traditional indemnity insurance is what many people "think" they have, only to find out it's something much less. Sometimes it's not even really insurance but a dental "plan". There are two basic types being offered as an alternative to traditional insurance. The most common type is the PPO (Preferred Provider Organization), which asks the dentist to accept anywhere from 25-75% less than their usual fee in exchange for access to a pool of patients that are encouraged to choose a dentist “off the list.” The patient can still see whomever they choose, as long as they’re willing to pay the difference between what the PPO’s fee schedule allows, and what their dentist’s normal fee is. PPO systems create an environment that induces the dentist to do as much as possible, seeing more patients during the day, and sometimes working longer hours, to make up the loss. It’s difficult to provide personalized attention and do quality work in a rushed fashion.

The other type is called capitation, and is not insurance, but a dental “plan.” No claim forms are needed, since the dentist can not file a claim for reimbursement. Dentist’s who participate in these plans have agreed to accept roughly $7.00 per month for one person ($15.00 per month for an entire family), in exchange for a pool of patients that have chosen them from a list of participating dentists. The patient pays nothing for preventative visits, and a small co-payment for restorative services. $10.00 for a filling, on up to about $180.00 for a crown, are close estimates. Other than the $7.00 per month, this is all these dentists receive. These type of plans encourage just the opposite of a PPO plan, which is to see as few of the patients on your list as possible. There is also an inducement to limit how many patients with these plans the office sees in one day. Since no one can stay in business very long while adjusting off virtually all the fees....many patients complain that it takes quite some time to find an opening for an appointment. Since they lose money when the patient comes in for treatment, recall cards for check-ups aren't always sent out. Obviously, $7.00 per month doesn’t buy much in the way of quality, care, concern, cleanliness, and attention to detail. Employers choosing this plan for their employees can only be interested in cost containment, not quality. Capitation plans are sometimes offered “free” to employers by the insurance companies if they will take their medical coverage. One of the things both of these plans have in common is that virtually any dentist with a license, and adequate liability insurance qualifies. The end result with both is a system that manipulates not only the healthcare provider, but the patient as well. Most patients don’t want to be involved in a system that encourages either overtreatment, or under treatment of their needs. More often than not....it is the "mass production" clinics that participate with these "plans".

If you are stuck with a dental plan that limits your choices, or your access to the care you would like to have....be sure to let your employer know of your desire to change to a plan that offers some level of freedom of choice at the next opportunity to change. You will RARELY (if ever) find a Level III or IV Dentist who participates with a capitation style dental plan.

Back to the Previous Page