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Dental Health Maintenance Organization Plans |
There are three types of discounted dental insurance plans. These include dental health maintenance organization (DHMO) plans, dental preferred provider organization (DPPO) plans, and dental exclusive provider organization (DEPO) plans.
In a dental health maintenance organization plan, an insured patient can receive dental care services from a specified network of dental care providers. This will be in exchange of a lump sum prepayment by the insured person to a DHMO insurance provider.
A dental health maintenance organization plan is also known as a capitation dental insurance plan. The insured patient can of course choose to get dental treatment from a dental care provider, who is not a part of the specified network. In that case, the insured patient will have to foot the entire dental treatment expenses.
Dentists, who are part of the specified DHMO network, are required on their part to provide free services to insured patients under the scheme. They cannot refuse to treat an insured patient.
The DHMO insurance provider pays a fixed monthly amount per insured person to a specified dental care provider. This is regardless of what procedures are performed, what treatment has been provided, or whether an insured patient has been provided treatment or not.
However, the specified dental care provider gets from the insured patient a part of the fee based on the number of visits made by the insured patient.
DHMO plans are closed dental plans. This means that an insured patient, who expects insurance cover, cannot go outside the specified DHMO network to receive dental treatment.
Coverage norms under DHMO plans include various dental treatment services. These comprise basic treatment services. Such services include regular dental check ups, teeth cleaning, and even dental x-rays. They also include dental procedures that include dentures, bridgework, and dental crowns. Most of these basic treatments may be provided free of charge by the dentist under the plan. Some costs associated with some dental procedures may have to be footed by the insured patient.
DHMO plans are not preferred by most dentists. This is because of their fear of losing money if required to provide expensive services to insured patients. This is notwithstanding the fact that the insurance provider pays them a fixed payment per patient once per month. Even dentists, who become part of the DHMO network, do not provide the requisite standard of services to insured patients due to the fear of money loss.
Due to the above reasons most dentists prefer joining DPPO networks. Due to this factor, the number of dentists in a DHMO network becomes less. This means that insured patients under the DHMO plan have a narrow base of dentists to choose from.
From the point of view of an insured patient, the advantage of a DHMO plan lies in the knowledge that the DHMO enrolled dentist cannot refuse to provide him dental care. Another advantage is that various DHMO plans are offered by an insurance provider to help an insured person to reach a reasonable compromise between the coverage required and the money they can afford to pay for it. |