Question:
Now I'm not sure who are the conmen (or women)- HMO didn't want to send the
fax or the office is playing dumb and just doesn't want HMO business. If
that's the case they should just say so "hey, I'm not accepting that plan,
sorry", and should have not put themselves on the list!
Now, I have to plow through a list of other offices and try to get referrals
from work colleagues on the same plan. I was just told don't go to the HMOs
main "dentistry farms" where they corral patients in and don't do very good
work. They say go to the private offices, you'll pay a copay, but you get
better service. Well I haven't seen the service yet - and I'm still trying
to get an appointment.
Any suggestions (aside from personally driving to a bunch of dentist's
offices)?
Answer:
Too bad--I know a good dentist in the Detroit area! ;-). But he
doesn't take HMO's either.
HMO's work if you play fair, but only for the insurance companies. If
you have the option, switch over to a PPO type plan. You may have
copays, but much greater chance of being treated right.
What plans do most of you dentists out there prefer? (aside from cash and
check payments ;-)
Seriously, what are the best, i.e. most widely accepted dental PPO plans
(would have to be private - b/c the employer won't switch from the HMO) that
provides the best coverage for the routine procedures, etc?
Blue Cross?
Blue Shield?
MetLife (not sure if they have private plans)
Delta (seems like an HMO)
Others?
I don't accept any PPO nor any HMO plans. No dentist I know locally does
either. The only dentists accepting these plans in the Detroit area I ever
met were heavy into bait-and-switch. I know of a dentist on the East Coast
who accepts a few of these plans and is sincere and qualified, but that does
you no good.
What you are experiencing is typical HMO shuffle. The dental office only
makes a profit if you never get an appointment. They are trying very hard
to keep you out of the office. With an HMO system, the dental office is
getting paid a few dollars monthly once you sign up with their office. They
get NOTHING more if you have any treatment performed.
My suggestion would be to get out of the capitation plans ASAP.
Most of the big PPOs are decent--that is, the fees are generally reasonable
to me--that is, not too far below my regular fee. You must be aware that PPO's
mean that the dentist is contractually obligated to perform COVERED services for
the stipulated FEE, and that this fee is not necessarily the same as the
BENEFIT. Some PPOs have a fixed dollar benefit, but most of the larger plans
pay a percentage of a stipulated fee, depending on what kind of service. A
typical plan (for example) might pay first-dollar coverage at 100% for exams,
x-rays and routine cleanings, but have (say) a $50. deductible on other
benefits, and then pay 80% of the allowable fee for fillings, root canals and
gum treatments, and 50% of the allowable fee for prosthetics (crowns, bridges,
and dentures). Generally cosmetic treatment and implant-related care have no
benefits.
The most important thing to know is that generally no plan you can buy as an
individual follows this pattern. Most of the plans you can buy as an individual
are a waste of time. I could get into why if you need to know, but a google
search of insurance plans on this ng will tell you more than you could ever want
to know about dental insurance. If you work for a relatively small company and
other employees have used the hmo and had problems I would consider talking to
whomever manages your benefits and consider switching to a ppo or establishing a
medical savings plan.
