What is a PPO or DPO? |
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Don’t think for one moment that these are a special superior group of dentists. These dentists basically have contracted with a dental insurance company to accept a lower fee in exchange for more patients ( although not guaranteed). These dentists basically have contracted to " purchase patients". The dental insurance companies then sell these lists of dentist ( now called " preferred providers") to business looking for a cheaper more affordable dental insurance. This is an effective way for businesses to continue to provide benefits to employees at reduced costs. Dentist contract with an insurance company usually for a two year period at which time either party can terminate the relationship. It is not uncommon for the pool of participating dentists to change from year to year. Participating dentists may not be located in the same geographical area where patients live and work. There is usually a limited number of dental specialists that participate. Patients are limited to choose only those dentists that are contracted…if they choose a dentist outside of the PPO network there is often a substantial loss of benefits. If the patient switch to a PPO/DPO from a traditional plan and back again he/she will lose any incentive clauses from the former plan For example: Often times the percentage of benefits paid out by a insurance company increases over time. If a patient chooses to discontinue that plan they lose this incentive if they decide to return. Who wins and who loses in a PPO or DPO plan? Dentist whom contract with a PPO elect to take a 20-50% reduction in fees. To cover a drop of 20-50% in revenue contracted dentists need to provide in excess of 40% more dentistry with the same staffing, office , and time scheduling within the same patient pool. Some contractual dentists feel that with the additional pool of PPO patients even more dental services will be needed , far greater than the 40% needed to meet overhead demands. Implementation of time saving procedure and procedure selection such as delegation to subordinates, less time with patients, using cheaper dental laboratories, adjusting appointment times, and prioritizing more profitable procedures, and incentive to handle more complex/expensive cases " in-house"…are some of the adjustments made. The question becomes can dentists do this and still maintain the necessary standard of care???. After the dusts settles: the insurance company has paid our less benefits in term of premium dollars, the employer has reduced costs while continuing to offer employees a dental benefit, and the patient receives care from offices that have contracted to receive larger volumes of patients for lower fees…who do you think loses????? The premium difference for the patient’s co-pay for a traditional dental insurance plan versus a PPO is about $4.00 per month. Return to Dental Resources Top ©1998, Jeffrey Kohlhardt DDS, 1204 Cottonwood Street, Suite 4
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A
dental PPO or DPO stand for " preferred provider organization"
or " dental provider organization" . In some states they are
called selected providers, premier providers , choice
providers…etc.