HMO is a Health Maintenance Organization dental plan and is sometimes referred to as pre-paid plans or a capitation plan. This plan requires you to choose one dentist or a dental office to coordinate your oral health needs. If you need to see a specialist, your dentist will have to refer you and some specialty care may require preauthorization. If you decide to change your dentist, you must tell your insurance provider so that they can transfer you to the new dentist of your choice. With an HMO plan, there are no waiting periods, calendar year maximums, no deductibles, nor claim forms to be sent in. Instead, you will pay a fixed dollar amount for the dental services provided. Most HMO’s have no copayment for preventive care and diagnostic care, but they do have an office visit fee that must be paid each time you see the dentist.
Things to Consider with an HMO Plan
• The monthly premiums are usually the lowest with the least flexibility.
• Check to be sure that your current dentist does excepts the HMO plan.
• You must select a provider in network, you can’t go out of network.
• You must be assigned to the dental provider before you can be seen.
• Check to see how many dental providers and specialist there are in this plan.
With an HMO dental plan, a group of dentists provide broad and affordable care at a low monthly premium. Most of the work is done at no cost or at a reduced price. If you choose a HMO plan, get to know the plan’s rules so that you can make the plan work for you.
I hope this Tooth Talk has answered your questions about an HMO insurance. Please call (615) 445-8700 or email me [email protected] if you still have questions. Integrity Dental Care, PLLC