Capitation or HMO
Capitation plans are another form of managed care. They are also called a Dental Health Maintenance Organization or HMO. Participating dentists are paid a set amount for each person enrolled in the plan, rather than for actual treatment provided and whether they visit the dentist or not. Unfortunately, this type of plan encourages a "significant delay" in treatment, minimal services and the use of lower quality material. In other words, the provider looses money every time you require treatment or need to be seen, although a small co-payment is due at each visit.
The best financial situation for participating
providers is to delay care or limit treatment options to
the least expensive option regardless of desires you may have
for higher quality care. And you can only see participating dentists
and specialist, regardless of the quality of care you feel
you are receiving. If you decide to see a dentist which is
not on the HMO list of providers, charges for service will
not be covered by the plan. Only about 73% of the monies
spent on a HMO program goes to actual patient care. The remaining
27% goes to the insurance company.
“We love you—all my friends go to you! Your practice is so wonderful! I have dental anxiety—but I have no worries at Pacific Family Dental! They are very professional with dentristry and concerned about patient cost.”
—Kathy Devlin
