The Truth About Managed Care

In managed care situations, the dentist is being paid a fixed amount per family that signs up for treatment in his office. He will be reimbursed the same amount whether he performs comprehensive care, or (illegally) has a dental assistant run a cleaning cup around the teeth and call it a cleaning.

There is no incentive to treat comprehensively since the reimbursement is going to be the same (perhaps with a minor financial "co-pay"). Examinations are cursorily performed with dull explorers, out-of-focus X-rays, and someone else's eyeglasses.

Some managed care providers may limit the appointment times available for managed care patients in their practice. This means that it may be difficult to find an appointment time to meet your schedule. You may also encounter delays in seeing your dentist as well as special restrictions on your treatment. These factors will detract from your overall dental experience and make you reluctant to accept the prescribed treatment.

There are several factors at work here:

1. The dentists must act as "gate keepers" to limit the numbers of HMO patients they see in any given period of time.

2. The dentists who try to run a hybrid (mixed traditional and managed care) practice must wear different hats in examining a treating patients. This gets very confusing, and leads to a lower standard of care for all patients.

3. The patients with traditional insurance in a hybrid practice will witness their fees increase, as the dentist tries to compensate for the financial shortfall created by accepting mangled care patients.

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