<P>15© 2009 AAPD All rights reserved. Dental Health Maintenance Organization (DHMO) Insurance Plans The DHMO Plan has a network of dentists. However, these dentists offer a discount to clients who are part of the same insurance company because the insurance company offers them a prepayment. In general, when using these plans, the patient can only go to dentists in the network. If the patient chooses a dentist out of network, the insurance pays nothing. When the plan purchaser reviews a DHMO or capitation plan, the following factors should be considered: • What percentage of the premium is used for administration? • Does the employer have access to suf?cient information to determine the level and amount of treatment received by each member of the group? • What is the utilization rate for patients in this program? What is the average waiting period for an initial appointment? What is the average period between appointments? • What is the dentist/patient ratio for the program? What are the criteria for selecting dentists to participate in the program? What is the geographic distribution of patients to dentists? • What is the ratio of dentists accepted to the program to those who applied to participate? How many dentists voluntarily withdrew from the program over the past two years? • What is the capitated rate of compensation for the dentists? Is it suf?cient compensation for the needs of the covered patient population? What provisions are made for unforeseen utilization or dif?cult cases? • What are the bene?ts for patients requiring a specialists care? How are specialists selected and compensated? Does the plan have adequate specialist participation? • Who controls treatment decisions — the patient and the dentist or the dental plan? Many plans require dentists to follow treatment plans that rely on a Least Expensive Alternative Treatment (LEAT) approach. If there are multiple treatment options for a speci?c condition, the plan will only pay for the least expensive treatment option. If the patient chooses a treatment option that may better suit his/her individual needs and long-term oral health, the patient will be responsible for paying the difference in cost. Its important to know who makes the treatment decisions under the chosen plan. These cost-control measures may have an impact on the quality of care youll receive.</p> <UL><LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/1/1/">Front-Cover</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/2/2/">Inside-Front-Cover</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/3/3/">Page-3</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/4/4/">Page-4</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/5/5/">Page-5</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/6/6/">Page-6</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/7/7/">Page-7</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/8/8/">Page-8</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/9/9/">Page-9</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/10/10/">Page-10</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/11/11/">Page-11</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/12/12/">Page-12</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/13/13/">Page-13</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/14/14/">Page-14</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/15/15/">Page-15</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/16/16/">Page-16</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/17/17/">Page-17</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/18/18/">Page-18</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/19/19/">Page-19</a></LI> <LI><a href="http://www.stallionpublishers.com/publication/1603/hvvyzehvw/20/20/">Back-Cover</a></LI> <LI><a href="http://www.stallionpublishers.com/publications/1603/x/sitemap.xml" target="_blank">site map</a></LI> </UL>

 

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