Managed Care

HMO/PPO Provider vs. Private Care Dentist

"How come you're not on the list of dentists my company wants me to go to?"


This is a question we are often asked by our patients when their company switches to an HMO or PPO dental plan, and we hope to clear up much confusion by answering it.

Every dentist is solicitated by three or four insurance companies a month to join their family of HMO/PPO dentists. Contrary to popular belief, there is no quality control or screening process to select top dentists in the area. In fact, the insurance companies make no evaluation or assessment of a dentist's clinical skills whatsoever. Basically, the only two requirements I've ever seen to sign up as a HMO/PPO provider is 1) do you have a license to practice and 2) do you have a heartbeat.

The promotional material provided to you the patient by this multi-billion dollar insurance company is very appealing. It makes it sound like you've just hit the lotto and there really is a free lunch, or so it seems that way. It appears that every one wins in the deal, you, the patient, now get free ( or greatly reduced ) cleanings, x-rays, exams and perhaps even fillings. Even the major treatment is much cheaper ---- you're ecstatic. The upper management of your employer has a much cheaper dental insurance premium to pay each and every month ----- they're ecstatic. If you have been following the profits of these HMO companies, you are aware that they are making money hand over fist. The insurance company executives are among the highest paid in the business world ---- they're more than ecstatic, they're doing handstands to work!

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