HMO Dental Insurance Plan is a plan that forces its members to see only in-network dentists. Most HMO plans (also known as DMO) work on a capitation basis. That means that the plan pays the dentist a certain amount per member every month, whether or not the member sees the dentist. However, when the patient does come, the dentist is not allowed to charge the patient or the insurance anything for many procedures, and a very minimal co-pay for the rest. The participating dentist hopes that the monthly check will cover any procedures the patient may need.
Unfortunately, this arrangement creates a very complicated situation. The dentist receivesvf the monthly check for all members, some of whom he will never see. In fact, he hopes that he doesn’t see many patients on his list – because when a patient does come, the dentist is basically working for free. As a result, many HMO patients find it difficult to make appointments at participating dentists, because the dentists severely limit appointment times available to HMO patients.
We believe that this arrangement does not serve the best interest of the dental patient. We feel that patients with HMO Dental Insurance often do not get the quality dental care they deserve, as it is almost impossible to deliver top quality dentistry with this arrangement. That is why we do not participate in any HMO plans.
We are not the only ones that feel this way. Vast majority of dentists in Westchester do not participate in these plans. For many dental patients from Harrison, White Plains, Scarsdale, Rye, New Rochelle, and Mamaroneck, finding a dentist “in-network” is difficult, and getting in at a convenient time nearly impossible. And if they have to see a specialist, like an endodontist, orthodontist, periodontist, or oral surgeon, finding a Westchester dental specialist is even more difficult. Most towns simply do not have any in-network dentists, like Rye, Harrison, Scarsdale, and Mamaroneck.
For these reasons, we encourage our patients who have them to switch to a PPO option that is frequently offered as well. Dental PPO allows its member to see any in- or out- of network dentist, and the benefits are usually the same. The patient is not restricted to one or two dentists in Westchester, but is able to see most dentists close to his or her home or work. The arrangement works better for the patient and the dentist, and results in proper dental care being delivered.