Managed Care in Dentistry

Third-Party Payment For Dental Care

In recent years, there has been a significant increase in so-called "managed dental health care" in which insurance groups make contracts with local companies to provide dental care for specified fees and with numerous regulations and stipulations for patients. Your employer may purchase dental benefits for you using a managed care program with its advantages and disadvantages.

Other than paying for dentistry yourself without any involvement with insurance companies, there are several payment concepts currently popular:

Indemnity Dental "Insurance" Plans

(These organizations offer standard dental treatment at near normal fees with a choice of practitioners.)

These groups are the original managed care organizations in dentistry. Many dental patients have been on these plans for decades. They provide payment to dentists at fee levels that generally allow quality oral services to be provided. One of the only disadvantages to some of these plans is the high administrative-cost charged to you and your employer. Thus, you receive less dentistry than the funds your employer pays into the benefit company. Nevertheless, these indemnity "fee for service," freedom of practitioner choice, dental "insurance" plans have provided adequate dental services for Americans for decades.

PPO (Professional Provider Organizations)

(These organizations offer partial payment for dental treatment at reduced fees as provided by specified practitioners.)

A dental benefit company (PPO) contracts with your employer to provide financial benefits for dental care for you. The dentists who participate in the PPO plan agree to treat you for reduced fees. They are called "preferred providers." Usually, only a few dentists in a community participate. Often, they are younger dentists, or a few mature dentists who have various reasons for their participation. Many dentists do not participate in PPOs because the reduced fees limit the dentists' ability to provide services at their usual level. Dental benefit companies administering PPOs are in "business" for profit. The profits go to the PPO owners. With the myriad of new innovations in dentistry, it is impossible for updated practitioners to provide high-level, standard-of-care services on a continuing basis to you at reduced fee levels. Be careful! If you elect to join one of these plans, you can expect only maintenance level care, usually without elective services such as implants, esthetic dentistry, orthodontics, and other treatment. These plans vary enormously in the benefits they pay and quality of oral care the participating practitioners can provide.

HMO (Health Maintenance Organizations)

(These organizations offer minimal dentistry at low fees by specified practitioners.)

Perhaps the greatest current threat to quality dental care in the U.S. are the currently available, underfunded dental HMOs. A dental benefit company (HMO) makes a contract with your employer to provide "overall" dental care for you at very low fee levels. Capitation payments to dentists from many dental HMOs will not even provide the total of 2 dental "cleanings" (scaling and polishing) per year. The dentist receives a few dollars per patient per month, whether the patient is treated or not. Obviously for financial reasons, the dentist would rather not see the patient, and certainly would rather not do any expensive treatment, almost all of which must be donated to the patient by the dentist. Generally in dental HMOs, the dentist can only survive financially by not treating the patients. Who profits from dental HMOs? Certainly not the patient or dentist. You guessed it, the HMO owners! As in some PPOs, if you elect to join a dental HMO, you have a group of preferred providers who participate in the plan for various reasons. Fortunately, after many companies have come and gone, the use of dental HMOs is diminishing.

There are a few large dental HMOs with historical evidence of relatively acceptable levels of dental care. However, these are exceptions to the previous statements. Your dentist can easily tell you if the dental HMO plan you are considering provides adequate funding for dental services.

Direct Reimbursement Plans

An excellent and growing form of payment called Direct Reimbursement (DR) can be obtained by your employer, in which you have complete freedom of choice about practitioners and the quality level or type of service you want, without major overhead costs to your employer. We will be pleased to provide information on our doctors if you want it for your employer.

Americans enjoy freedom in nearly all areas of their lives. I think you want to choose your health practitioner based on your own criteria, and you want the very best preventive-care practitioners and treatment you can get. I doubt if you can trust profit-motivated companies to select your practitioners, dictate their fees, or limit their services. Only three of the four methods for payment described above preserve "freedom of choice" dentistry (indemnity dental "insurance" plans, referral networks, and direct reimbursement).

Thank you for your support. We look forward to serving you with high quality, moderate cost, freedom of choice dental services.