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health advisory Hospital Dentists Yu 2007-11-11 18:16:54

Answer:

It is horrible insurance where the dentist is paid not to see you. Once you are assigned to a certain office, the dentist will begin to receive a fixed amount every month, often something like $10. For this, they are expected to provide all of your examinations, x-rays, cleanings, fillings, extractions and root canals with no additional reimbursement. If you need a denture or a crown, there is a co-pay required of the patient that pretty much covers the lab fee if the dentist can find a lab that works cheap enough.

You can see why it is a losing proposition for all parties. I had a patient in my office who was considering switching to a capitation plan. She called the dentist and identified herself as a "cap" insurance member. They gave her an appointment SEVEN MONTHS in the future. I called back myself and said that I was a member of the plan she currently had, which was a "UCR fee-for-service" plan (in other words - full payment by the plan plus the patient) and they had an opening the next week.

The dentist would begin receiving the cap payment as soon as the patient had enrolled. His plan was to wait long enough so that payments received would cover the overhead of the first visit before seeing the patient. This is probably illegal, but it is done all the time. Nobody benefits from capitation insurance except the company that sells the plan and collects the premium.

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IT IS WHERE THE DENTIST GETS A CERTAIN RIDICULOUSLY LOW FEE AND IT MUST COVER EVERYTHING. MOST DENTISTS DONOT SEE PATIENTS WITH THIS KIND OF COVER.

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