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Insurance Decision-DMOs
Septus
Registered User regular
Registered User regular
I'm about at the end of my enrollment period for my dental insurance, and I have the option of switching from my current PPO, to an HMO. The only point of doing so would be to cover braces, since my current PPO does not cover that at all. Uncovered, it's $6500, and with an HMO it's about $2100. That's a huge difference, but considering the time involved, my own personal issues with having braces at my age, the discomfort and everything else, I really don't want to go through with this unless I'm getting a pretty damn good treatment.
That being said, I'm curious about anyone's experience with HMOs and how that payment method may affect treatment. Considering the limited number of providers, and the set dollar amount, I can't help but wonder if there will be pressure of some kind on the orthodontist to pursue less than optimum treatment methods. The orthodontist that I already visited with, the one that may very well be the best in town, but also terribly expensive, tells me that with my case, an HMO provider might push for a more standard ortho treatment, and then jaw surgery to finish it up. I'm taking that with a grain of salt because I'm being told this by the office that wants my money.
Anyone care to share their experience with quality of care for HMO providers?
That being said, I'm curious about anyone's experience with HMOs and how that payment method may affect treatment. Considering the limited number of providers, and the set dollar amount, I can't help but wonder if there will be pressure of some kind on the orthodontist to pursue less than optimum treatment methods. The orthodontist that I already visited with, the one that may very well be the best in town, but also terribly expensive, tells me that with my case, an HMO provider might push for a more standard ortho treatment, and then jaw surgery to finish it up. I'm taking that with a grain of salt because I'm being told this by the office that wants my money.
Anyone care to share their experience with quality of care for HMO providers?
PSN: Kurahoshi1
Septus on
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I personally had shitty experience with an old DMO, but the fee scheduiles don't necessarily have to be garbage. I'm also assuming the for ortho there is still at least a 20% coinsurance. It all boils down to, whether or not there is a competant provider in your area that accepts your coverage.
The dentist will be providing your care, not his admin staff.
Generally, PPOs have more leeway from selecting doctors and slightly higher copays, but cover more overall when big stuff goes down. HMOs are generally cheaper on the copay, have more restricted doctors, and pay for less on large issues.
In eaither case, you get screwed. Read everything extremely closely. My experience has been with United and Aetna, others may and probably do vary.
Well shit, the coinsurance thing sounded weird, so I checked it again. With the DMO I only pay the flat $2100 for orthodontistry performed by a general dentist, which is not something I'd ever want to do. For an orthodontist, I'd pay 75% of full cost, however the providers are still very limited.
I think I'll go ahead and shell out the extra $1500-2000 for seeing this better guy, rather than going somewhere else for what I thought was a $4600 difference.
Yeah, I did that with some other procedures. In this case though, I don't think it'd apply. The DMO plan has no annual cap, and the PPO plan gives no coverage for this at all.
Is this a medical PPO, because a dental PPO with no ortho benefit seems a little off to me. It's been years since Ive dealt with the industry but that is an odd thing to leave off the benefits schedule.