An Explanation of Third Party Payment For Dental Care

Serving Fort Lauderdale, Boca Raton, & Miami

In recent years there has been a significant increase in so-called managed health care in which insurance groups make contracts with local companies to provide health care for specified fees and with numerous regulations and stipulations for patients. Your employer may attempt to provide dental insurance for you using one these managed care programs. The following information will be helpful to you as you attempt to understand the concept and its advantages and disadvantages.

In our area there are basically two types of managed care programs as follows:

PPO (Professional Provider Organization)

An insurance company owning the PPO contracts with your employer to provide dental care to you. The dentists who participate in the PPO plan agree to treat you for significantly reduced fees. They are called preferred providers. Only a few dentists in the community participate, usually younger dentists or mature dentists with less active practices. Dentist with active practices providing modern standard of care updated dentistry cannot usually participate in the PPO's because of low fees and inability to provide services at their usual high quality level.

Insurance companies providing PPO's are in business for one purpose -- profit. They use dentists in need to staff their programs. The profits go to PPO owners. In today's world, the myriad of new innovations in dentistry, it is impossible for updated practitioners to provide high level standard of care services on a continuing basis to you at the fee level provided by most PPO's. If you elect to join one of these plans, you can expect only maintenance level care with few innovations provided by practitioners selected by the PPO owners.

HMO (Health Maintenance Organization)

Perhaps the greatest threat to quality health care in my many years of practice is the currently in vogue HMO. An insurance company HMO makes a contract with your employer to provide overall health of dental care for you at an unbelievable low fee level. In our area, the fee levels of most dental HMO's will not even provide the total of two dental cleanings (scaling and polishing) per year. The dentist receives a few dollars per patient per month, whether the patient is treated or not. Obviously, the dentists would rather not see the patient and certainly would rather not do any expensive treatment, almost all of which must be donated to you by the dentist. Generally in HMO's, the dentist can only survive financially by not  treating the patients. Who profits from HMO's. Certainly not the patient or dentist. You guessed it -- the HMO owners! As in PPO's, if you elect an HMO, you have similar group of preferred providers who participate in the plan for the same reason, usually observable by discerning patients.

Summary

I'm sorry if I have not painted a beautiful picture. Unfortunately, managed care is not an admirable development in American health care. It benefits primarily the owners of the insurance companies -- not you!

Traditional fee-for-service, freedom of choice, freedom of practitioner choice, dental insurance plans have provided excellent dental service for Americans for decades, and they still do.

Additionally, a newer form of dental insurance called DIRECT REIMBURSEMENT (DR) can be obtained by your employer, in which you have complete freedom of choice about  practitioners and the quality level of type of service you want. We will be pleased to provide information on DR if you want it for your employer.

I sincerely hope that you love the American way as much as I. This is a free country. I want to choose my health practitioner based on my own criteria, and I want the very best preventive care and treatment I can get. I don't trust profit motivated companies to select my practitioners, their fees, or their services. We will be privileged to provide the best quality oral services to you available today, but I'm sorry I can't provide such care in any PPO or HMO.

Gordon J. Christensen, DDS, MSD, PhD CRA Oral Health Institute

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