Dental Health Maintenance Organization
A dental health maintenance organization (DHMO) is a capitation dental insurance plan, and one of the two most popular plans available. In these sorts of plans, the patient pays their network dentist an agreed rate per person, either individually or for a family, as opposed to paying for single treatments over the course of a year.
Network Dentists
As health insurance HMOs do with doctors, DHMOs contract certain dentists to be part of a network. When a citizen becomes a member of the DHMO, they are able to select a dentist from a list of those associated with the network. If they want or need to utilize the services of a dentist outside of this network, they will incur far greater charges as the DHMO will not pay for any of the bill. This system helps the insurer to limit their own costs while offering financial incentives for patients to join their plan and use in-network dentists.
Payment
Prepayment is required for DHMO membership, as the patient is charged not for specific treatment but their overall service. Typically there will be a monthly premium and possibly a small copayment for each office visit. These premiums are less expensive than dental preferred provider organization plans, and have no deductible (the amount the patient must pay before the insurer does) unless hospital dentistry is necessary.
Coverage
DHMO plans will cover basic services including x-rays, frequent dental exams, and teeth cleaning. Depending on the plan, these may be provided free of charge when using in-network dentists. More in-depth procedures, such as fitting dentures, dental crowns or dental bridges, usually require copayment with the insurance provider, but the DHMO pays a higher proportion.
Advantages
One of the most tempting advantages of DHMOs is their cheapness relative to most other types of dental insurance, as detailed above. There is also a feeling of security that patients get with DHMOs, as dentists within the network are forbidden from turning away eligible patients regardless of whether they will receive full compensation (because the dentists are generally paid a fixed amount by the insurer). In addition, most companies offer a large selection of DHMO plans to suit your needs, allowing people to weigh up the amount of coverage they require against the sort of money they can afford to spend.
Disadvantages
As the payments are lower, this also means patients are considered lower priority when seeking treatment that is not ‘basic,’ such as fillings, crowns and other procedures. It is not uncommon for DHMO members to wait for months before they can obtain such treatment. The other main disadvantage is the inflexibility of the program: if for whatever reason you cannot or do not use an in-network dentist for particular dental work, e.g. during a trip or for wider choice, then you are liable for all of those dental costs. This means choice is limited to the dentists within the network if you wish to claim money from the insurance company.