What Are the Advantages of Dental Health Maintenance Organization?

There are several options out there to get help paying for your dental healthcare, and one of those options is being part of a dental health maintenance organization. If you are part of a DHMO network, you need to understand exactly how it works. What is a dental health maintenance organization (DHMO)? How exactly does a DHMO work? Can you benefit from a DHMO?

What is a Dental Health Maintenance Organization?

A dental health maintenance organization is sometimes referred to as a capitation dental insurance plan. It is a type of insurance where a group of dentists, or a single dentist, joins in a contract with the DHMO to provide dental treatment for the patients who are a part of the DHMO. The organization pays the dentist a certain amount per patient who is enrolled in the group. The dentist then must provide all dental treatments to these patients. Sometimes, if the contract specifies, the patient pays a co-payment for certain treatments, while paying nothing for standard treatments, such as exams and cleanings.

In a DHMO, the patients must visit only dentists that are part of the DHMO network. This can range from one specific dentist to a group of dentists, depending on the arrangements.

Who Administers DHMO Plans?

DHMO plans are administered by insurance companies. They negotiate the arrangements between the dentists and their company. Because the plan is administrated by insurance agents, at times they may not make the best decisions for the patients.

Features of DHMO Plans

Patients in a DHMO are in a closed panel. They will have a limited number of dentists they can choose from. Extreme DHMO plans will have only one dentist on the plan.

Since the dentist is paid a fixed amount per patient, he often offers preventative maintenance care at little to no cost to the patient. This is because he will have the same amount of pay no matter what procedures they provide. When watching their bottom line, the dentist often does what it takes to keep patients healthy, rather than needing to do complex procedures. On the flip side, dentists are not motivated to provide treatment because they are paid no matter what, sometimes it can be difficult to get access to care.

Services Offered by DHMO Plans

DHMO plans usually provide all normal dental care. The focus of dentists in a DHMO network will probably be preventive care for their patients, as they make more money with the smaller amount of complex procedures they perform. Corrective dental care is also provided under most DHMO plans. However, access to corrective care can be hard to get with DHMO plans. Since the insurance company negotiates the terms of the contract, each DHMO plan will be different. Many choose not to cover cosmetic dental procedures, as they are not considered necessary. Often, this will include orthodontics.

Advantages of DHMO Plans

The main advantage of being part of a dental health maintenance organization is that it is one of the least expensive types of dental insurance. There is very little out of pocket expense involved with care while in a DHMO network.

Another advantage of being part of a DHMO plan is that there most likely will not be a waiting period. Other dental plans often place a waiting period that can be as long as two years on major dental procedures. They do this to ensure that their patients are not purchasing insurance just to get coverage for a major problem.

DHMOs usually do not have a deductible in the plan. While there are co payments, the insurance covers any procedure. You do not have to wait until the deductible is met. Not only that, but since the dentist is already being paid, there are not any complicated forms for the dental office to fill out.

Continue to : How to Use DHMO Benefits