PPO, DMO, Managed Dental Care Plans: Our Philosophy

Insurance policy

We Do Accept Many Insurance Plans

Dallas dentist Plano Richardson Addison insurance accept assignmentMany of our patients have dental insurance.  We are pleased to help you in managing your claims.  We do accept payment, known as assignment of benefits,  from your insurance carrier.  By doing this we minimize the cash-outlay for our patients.  You will find that we do all we possibly can to provide an accurate claim in a timely manner to your insurance carrier.  You will also find that we “go the extra mile” to make sure your carrier is providing good service to you.  Our patients value the way we can obtain a quick turn-around time with the highest benefit amount in an honest manner.  By managing insurance in this way, patients are minimally financially impacted and can responsibly handle their accounts with us in a fairly reasonable period of time.

 DMO Managed Dental Care Plans

I began my dental practice in 1986.  That was my first introduction into the managed dental care plans.  It was then that I learned about the DMO, capitation, or dental maintenance organization plans.  These resemble HMO plans for medical care.
In the DMO plans, the managed care dentist gets the practice promoted by employers as a listed provider in the DMO.  This is great for the dentist as it is basically free advertising.  This listing allows the dentist to be exposed to hundreds of potential patients.  The employees obtain the list of providers in the DMO and are required to select one of the dentists on the list.  Once enrollment in the DMO starts, the dentist gets paid by the insurer for each patient who selects that dentist, every month, whether the patient comes in for services or not.  So for the dentist this sounds great; “free marketing” of the practice and getting paid whether or not the dentist provides any services for the patients.   However, the downside for the dentist is that many preventive services are provided to the patient for free and other services are provided at a severe discount.  As a result, dentists may ration monthly the number of patients who are appointed in this type of insurance plan in order to squeeze profits out of the monthly payments received based on the number of patients who named that dentist as their dentist.
Philosophically, I do not understand how this is good for patients.  Why would patients want a dentist who gets paid best for not providing many services and for not seeing many patients?  There is not much incentive financially for the dentist to provide high quality care when they are not being well-paid per procedure.  As a result, I have never contracted with an insurer under this type of a plan.  I do not want to ration who can come to obtain care nor do I want to ration what procedures that I would perform on patients for financial reasons.  It makes more sense to me to get paid for work that I perform.   As long as I please my patients they will continue to see me, will continue to get procedures done, and will pay my practice for work performed.  In this more traditional manner of doing business, I have incentive to work and patients have control of payment for care I provided.  In the traditional model there is much more incentive for high quality care to be performed for patients.  Doesn’t this make more sense?  If you value a more traditionally-minded dentist who refuses to allow managed insurance plans to sacrifice his care for his valued patients, we invite you to contact us! 

PPO Managed Dental Care Plans

insurance assignment accept copayment easy comfortable paymentsPPO, or preferred provider organization, managed care plans vary quite a bit from the above plans.  Again, in this plan, dentists who have a contractual relationship with the insurer get their practices marketed to the employees whose employers offer this plan.  This marketing assists dentists in growing their dental practices.  In exchange for the marketing, dentists sign a contract which, among other things, limits the fees that are charged to patients.  They agree to a fee schedule.
By offering a lower fee schedule, patients may view this as a win for them.  However, based on the prevailing fees in my area, the fees are close to the cost of providing care.  In doing this, the “preferred providers” must find a way to run their practices by decreasing their costs of providing care.  Decreasing costs can be accomplished by hiring a smaller staff, hiring less experienced staff, double- or triple-booking appointment times, shortening appointment times, contracting with lower cost dental labs who make the crowns and dentures, using cheaper materials, locating their practices to minimize rental expense, etc..  Does decreasing costs make it more difficult to provide high quality care?
For my practice decreasing costs would sacrifice my quality of care.  As a result, I have not ever signed a contract with a PPO provider.  I did not go into business, into the dental care industry, to do anything but my best.  For me, these contracts would sacrifice my care.  It seems that patients want to obtain very good care as well.  So far, at this time in this great country of ours, there still exists ways to obtain very good dental care.  These managed insurance plans make it more diffiicult on the dentists to provide that very good dental care.  If you share my philisophy on receiving very good dental care, we invite you to contact us so we can help you. 

Saving Patients Money Another Way

The marketing of DMO-type plans and PPO plans to patients involves selling patients on saving money.  In these insurance plans, the premiums paid by patients are less and the fees for dental care provided are less.  This sounds great.  However, many dentists do ration dental care for business reasons.  As a result getting appointments may be more difficult.  In addition, since the fees are lower for procedures performed, quality of care may be sacrificed.
In my practice model, I save the patients money by being very honest with them on care that is needed, by providing high quality care which can last longer, by involving my patients in their treatment decisions, and by providing support to prevent future problems.  Work that is done well the first time with prevention in mind can save patients thousands of dollars over their lifetimes.  That is how we save our patients money.  That is why we have so many patients who have been with us for over 15 years.  If this is the type of care you desire, please give us a call to schedule any needed dental care at (972) 250-2580. 

Thoughts on Medical and Dental Care and Insurance

To start out, I can say that the dental care in the United States still is amongst the best one can receive in the world.  The insurance industry has not broadly influenced dental care adversely.  Most dentists are not contracting with insurance carriers.  By doing this dentists have more freedom to provide excellent care.  Contracts with insurance carriers can create barriers or difficulties to providing excellent care.  My practice does not have a contract with any insurance carrier nor do I anticipate it.  I would never want to sacrifice our ability to provide the best of care for our patients.
The medical care delivery in this country is much different.  The insurance industry has deeply affected the delivery of medical care.  Hospitals and many doctors feel forced to become contracted providers.  By doing so there are more obstacles to providing excellent care.  My family and I have experienced increased waiting times, more patients in the waiting room, decreased time with physicians, more pressure to see a nurse practitioner rather than the physician, and more common mis-diagnoses.  The current medical care environment is tough; physicians will admit to this.  The insurance industry has made the delivery of care more difficult, less personal, and less effective.  The current and future changes to health care from this presidential administration will make things much worse.  Change is needed in our health care system; however, not the change that was passed during the Obama administration.
As patients, you have more power than you think in questioning your doctors.  You can be more involved in the decision making process.  You can switch doctors if your doctor does not seem to be satisfying your desire for openness and quality care.  You can request from your doctor to explain things more fully or to offer more options.  You can find out if limitations are being placed by your insurance carrier; you can call you carrier and your employer’s human resources department to respectfully question your policy limitations and to request more benefits.
We consider it a privilege to provide dental care for our patients.  Fortunately we still can continue to provide amongst the best dental care in the world within our doors.  If you are interested in the quality of care we can provide, we invite you to contact us. 

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