The Differences Between PPO and DHMO

At your dental office, there are plenty of acronyms that affect your bottom line. Two of the most common ones you will encounter are PPO and DHMO. By understanding the core differences between PPO and DHMO plans, you can better serve your patients that utilize both and structure your practice to maximize production and collection.

PPO Plans

PPO dental plans allow patients a great deal of flexibility in choosing a dentist, but that comes at the cost of a deductible that is typically paid for any work that goes beyond normal exams and preventative cleanings. PPO plans also usually have larger co-pays. When it comes to your dental practice, PPO organizations are open to negotiating reimbursement rates and will reimburse you based on a percentage of the UCR rate for your zip code.

When you contract with an insurance company, your dental practice will be reimbursed based upon your fee schedule. Since many PPO providers are open to negotiations, the ‘inches’ that you negotiate can add up to serious profits on your end.

DHMO Plans

Dental Health Maintenance Organizations (DHMO) plans are not related to HMO health plans, despite the similar acronyms. DHMO plans have lower premiums for patients, often have no deductibles and cover a broad range of procedures. However, these plans assign patients to a specific dentist. On the practice end, these plans promise you a monthly capitation payout. These small fixed payments ($5-$15 based on the number of members your practice services) will make up your monthly lump sum. Patients are automatically assigned to your office, and you will receive a monthly payment whether or not you actually treated each patient that month.

While taking on as many patients as possible seems appealing, you must remember that you are responsible for caring for all of those patients. Many DHMO plans do not pay anything close to a UCR and ask patients to cover payments. However, this plan is excellent for stimulating a flow of patients that can then lead to patients who do not use a DHMO plan.

Choosing the Right Plan for Your Growth

There are many differences between PPOs and DHMOs, and it is important to consider the strengths of each plan when determining what is best for your dental practice. The experts at APEX Reimbursement Specialists can help you to explore the best options for your continued growth and sustained success. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.