"Dental Managed Care..."
Concerns about HMOs & DMOs"

"Patient Rights!"
Be a Discriminating Consumer!

Patient dental health and the practice of preventive care is the foremost goal of all conscientious dentists. Health (HMO) and Dental (DMO) Maintainance Organizations have been created for the purpose of delivering health care at minimum expense. Adversely, inherent in the design of their structure, are restrictions to the delivery of comprehensive care. In an effort to contain costs, physicians and dentists are limited in their choices of diagnostic and treatment modalities. With an eye on the bottom line, HMO and DMO programs may gain profits at the expense patient and provider alike.

    The federal government has recently intervened due to abuses in the system. HMOs may no longer impose a "gag order," preventing doctors from advising patients of alternative, comprehensive care that may endanger HMO profits. Unfortunately, the actions of the federal government may actually hinder its own efforts. At present, a strange quirk in federal law actually provides an unintended protection of HMOs against malpractice law suits by the consumer. 

    Patients must act first, rather than rely on the protection of government, to guarantee the well being of themselves and their families. Consumer protection agencies customarily take action against health care providers who grossly violate standards of practice, usually related to illegal drug, fraudulant activities, or sexual misconduct. Often understafted and described as "paper tigers," state licensing boards fail to provide appropriate safeguards when conflicts arise in the delivery of health care. 

    Apples and Oranges..:

    The biggest difference between a dental managed care program, and a conventional dental insurance plan, is that patients lose the right to choose their own doctor. If a company imposes a DMO on its employees, participants must choose among a list of dentists that have agreed to provide minimal care for the least cost, Conscientious Practitioners avoid these programs, rather than compromise the delivery of ideal care to their patients. 

    The consumer must be vigilant to these situations:

    • If an otherwise ethical dental office accept a DMO program, it may then provide retail dentistry and wholesale dentistry. Although the standard of care demands that the quality of treatment provided is independant of the cost, the harsh reality is that this may not be the case.
    • Appointments for a DMO patient are often few and far between. 
    • Office visits may be brief, with little or no treatment provided.
    • Treatment choices are usually limited to the least expensive options.
    • Large fillings may be placed instead of crowns. 
    • Removable appliances are chosen over fixed bridges. 
    • Many unfavorable conditions, such as periodontal disease, are often neglected.
    • The patient must usually see the general dentist first, for a referral to a specailists, who must also be a plan provider, at a reduced compensation. It is not likely to be the specialist that the dentist would select for himself, or members of his own family. 
    Fee-for-service dentistry affords patients more options, including their own choice of dentist! 

    Quality of Care

    The second conspicuous difference between DMOs and traditional dental care is that there is an inherent conflict between the level of care and dollars. Personal and individual attention to the patient, sacrificed in the name of "efficiency," results in assembly line dentistry. The artistic touch, the feel, the passion for creation -- essential components in the delivery of dental care -- invariably are compromised. With a large volume of patients, ushering people in and out of a full reception room, the dentist looses the personal contact with the patient he is attending.

    Protection Against Unacceptable Medical and Dental Care

    To insure successful, comprehensive dental care, it is important to have a family dentist who takes a sincere interest in the patient's general health. It makes sense to personally select and become individually acquainted with a dentist -- before a dental emergency arises. 

    HMO and DMO health care usually reduce patients to numbers, not individuals

    Employee Input 

    It is crucial for emplyers to be aware of legitimate concerns about medical and dental managed care. Cost cutting and company profits that contribute to a lower standard of community health care must not be tolerated. The "corporate anorexia" of the nineties needs limits. 

    • Participants in a health plan want to personally select and know their doctors.
    • Complete freedom of choice is essential to any health care plans.
    • Preventive care, an essential component of any prudent dental delivery system, is generally lacking in managed care programs.
    • In the long run, fee-for-service dental health plans offer better, more personalized health care, at less cost than managed care plans. 

    Material on this page was contributed by Jeffrey L. Wissot, DDS-FAGD & dentisty.com

Insurance | Fee For Service

based on abstracts from "How to be a Wise Dental Consumer," published by the American Dental Association