Our NYC practice, Tribeca Advanced Dentistry doesn’t accept any HMO dental insurances while we are taking most major dental PPO insurances. Why?
To understand why Tribeca Advanced Dentistry doesn’t think that it can efficiently provide high-quality dental care within the rules and limitation of a dental HMO (and its cousin DMO), we should consider basic economics. You may have seen dental HMO plans advertised on NYC subway, in newsprint, or local New York TV which offers dental coverage for as little as $10-15 a month or even as an add-on to an HMO medical health plan. To be fair, we have nothing against medical HMO plans which often provide quality medical care but at more affordable prices. Unfortunately, we cannot say the same about dental HMO, especially in NYC area.
When a dental office contracts to accept a dental HMO, a dentist agrees to accept greatly reduced fees from “Usual, Customary and Reasonable” (UCR) prevalent in the dental office area. To put it bluntly, the office is required to accept HMO fees which are “unusual”, “not customary”, and “unreasonable” by its own definition. To cover well below market price “uneconomical” costs, HMO makes up by paying its providers a monthly capitation fee of $5-10 per patient regardless of whether a dental patient ever comes to the office.
For example, dental HMO may only pay for a dental crown $250-$300 whereas our internal dental lab cost for a high-quality porcelain dental crown is $300 or higher (and that’s even before counting the costs of labor, dental supplies, and dental practice overhead!). This situation would put an ethical dentist in a moral dilemma: should I recommend a more expensive crown which a patient will have to cover out-of-pocket or go to a high volume but low-quality dental lab? If I recommend a patient a more expensive dental lab but with significant out of pocket expenses, it will look like a “bait-and-switch” tactic. If I place a cheap base metal crown, the patient may be back in my office complaining of poor results. My other option would be to do a “hard sell” of a dental procedure not covered by HMO for which I can charge a full price. None of these three options would be acceptable to our Tribeca NYC dental practice which strives for dental care excellence.
We often hear from our patients that past dental cleanings paid by NYC HMO were usually very short, lasting only 20-30 minutes, whereas our hygienist often takes a full hour. Many of HMOs pay such low prophylaxis fees that they wouldn’t even cover an hourly hygienist salary in NYC. Hence, HMO dental offices need to finish dental cleanings in a hurry.
Finally, the best outcome for an HMO dental practice in NYC is when the patients never use dental insurance at all. In this case, the practice collects a monthly capitation fee for each patient but provides no dental care. This may be the reason why many HMO dental offices have very long wait times as they want to discourage NYC patients to ever coming to the practice. All in all, HMO dental insurance providers economic interests often run contrary to the interests of its dental patients.
So do yourself a favor, spend another $20 a month and buy a good dental PPO insurance and come see us in our Tribeca Advanced Dentistry NYC office!