Dental Insurance

Why You Should Look at Dental HMOs… You owe it to yourself and your clients to do a little investigating. You’ll be surprised at what you find…
by Robin Muck

If you haven’t experienced the new dental HMO plans (DHMOs), you’re doing yourself and your clients a disservice. We all have to watch our expenditures since everything costs more these days and providing a dental HMO is a great way to do that. Convenience is another benefit. With a list of what is covered and what the costs are, there no need to fill out claim forms or wait for reimbursement from the carrier. Also, with no yearly maximums or deductibles, you get the care you need when you need it.

You may have been hesitant to offer DHMOs because of some of the old stories about these products. The good news is that there are dental HMOs that put these old tales to rest. With a little bit of homework and some knowledge of what to look for, you can provide your clients with excellent, affordable DHMO plans.
It’s the perfect time to start looking since it’s well established that when the economy goes down, HMO sales go up. With the economy on a downward track, now’s the time to find a good dental HMO benefits partner that can meet your clients’ future needs.
What would it take to convince you and your clients that there are some DHMOs providing high levels of benefits and excellent care? We can start by dispelling some of the misconceptions that have been circulating throughout the years.

Access to Care

Some worry that DHMOs offer a limited choice of dentists, it takes weeks to get an appointment, and specialty care referrals can take even longer. There are DHMOs that have worked to make these issues a thing of the past. They have expanded their networks to offer members a wide selection of dentists. Wait times for appointments have improved with the increased network size. Also, quality improvement programs have been developed in conjunction with the California Department of Managed Health Care to define and track appropriate appointment times. Each contracted dentist must meet standards to ensure that members get the care they need in a reasonable amount of time. When reviewing a DHMO, ask to see the DHMO most recent report on appointment wait times.

Specialty care can still be an issue if the DHMO requires contracted general dentists to submit referrals for approval before the member can get care. With the direct referral process, the general dentist can refer members to specialists without a pre-authorization from the benefits company. This speeds important treatment and allows the general dentist to be more involved in patient care and treatment outcomes.
When you’re looking for a dental HMO partner, make sure that it has the following:
• A large network of dental care professionals.
• An enforced policy that mandates reasonable wait times for appointments.
• Direct referral for specialty care.

Quality of Care

Another misconception is that the really good dentists don’t participate in DHMOs. In fact, dentists who treat DHMO members must have a high level of education and training. Conscientious companies thoroughly credential each dentist before accepting them into the network. On-site reviews are integral to the approval process.
Re-credentialing is also an important part of network quality maintenance. To determine whether to continue network participation, the process should at least include the following: license status, malpractice settlements, practice patterns identified in utilization data, complaint activity, and compliance with appointment availability.

Since contracted dentists are the face of the dental benefits company, it’s important for them to meet recognized dental care standards to ensure a positive experience for the DHMO member. The truth is that dentists in most DHMOs are highly qualified practitioners. But, with any service professional, each person needs to find the dentist with whom they are most comfortable.
Make sure that your DHMO partner has the following:

• Credentialing and re-credentialing programs to ensure high quality dentistry.
• A quality improvement program with ongoing oversight.
• A policy that allows members to change dentists with minimum effort.
Covered Benefits

There was a time when some felt that DHMOs were so focused on preventive procedures that they neglected other important services. A dental HMO is designed to promote regular visits to healthcare professionals by providing free or low cost preventive and diagnostic services. The reasoning, which is still valid, is that when you catch a problem early, the cost will be far less than it would have been if you delayed treatment.

Several DHMOs now have extensive lists of covered procedures. Some even provide bleaching and veneers as standard services. Other plans provide discounted fees for procedures that are not listed on the schedule of benefits. These procedures are covered at a co-payment, which gives the patient an almost full-range of services. These comprehensive plans consistently meet the needs of nearly every patient and usually for considerably less than the cost of indemnity or dental PPO plans.
The new comprehensive plans all but eliminate another concern: dentists telling DHMO patients that they need a more-costly procedure than what the plan covers. The most utilized procedures are all there, so there is little need to substitute a non-covered benefit. It is also important for patients to know that they can get a second opinion about a recommended treatment plan. Their DHMO should be able to supply the name of another dentist to provide a second opinion. Make sure that the dental HMO has the following:

• A selection of plans with an extensive list of covered procedures.
• Discounts on non-listed procedures, which is a great value-added benefit.
• The option to get a second opinion at no added cost.
If you’re locked in the “I only sell indemnity dental” mode, you owe it to yourself and your clients to do a little investigating. You’ll be surprised at what you find. Today’s dental HMO is convenient, cost-effective, and comprehensive.
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Robin Muck is the president of SafeGuard Health Plans Inc. of California. Robin has more than 20 years of experience in the healthcare industry with organizations, such as Novaeon, a national health and disability management company where she served as vice president of Sales and Account Management. At CCN, a national managed care company, she held various positions including vice president of National Accounts and Vice President of National Sales. Robin serves on the board of California Association of Dental Plans and the National Association of Health Underwriters. You can contact Robin at 949.425.4371 or robinm@safeguard.net