IF YOU THINK THE TREATMENT YOU NEED AND THE TREATMENT YOUR DENTAL BENEFITS WILL PAY FOR ARE THE SAME THINGS, THINK AGAIN. THEY ARE BY NO MEANS NECESSARILY THE SAME!
This office does not participate in dental managed care plans such as dental health maintenance organizations (DMOs, also known as capitation programs) and preferred provider organizations (PPOs). To explain why, let us help you understand how these plans work. After signing a managed care contract, the dentist is required to deliver care according to the terms of the plan. Under one arrangement, the dentist is reimbursed for each patient who signs up for dental care at his or her office from the plan's list. This is called a capitation plan. It does not matter whether these patients visit the doctor's office or not in given year, only that they are enrolled there. Managed care plan standards have nothing to do with the time the doctor spends with each patient or the quality of care he or she provides. They only depend on the number of patients the dentist can possibly manage (there's that word again!) to see. When these patients do need care, the doctor is often severely overworked by the sheer number of patients he or she is obligated to see by the regulations of the contract. This is how corners are cut and mistakes are made! If the dentist should refer patients to the care of a specialist, he or she will often lose their enrollment under the terms of the contract. What kind of dental care do you think you would receive under these circumstances? The answer is minimal at best with a specialty referral being more rare than snow in July.
Managed care rewards the quantity, not the quality, of care.
A preferred provider organization (PPO) works in much the same way. In this instance the doctor is reimbursed for much, but not all, of the care he or she delivers. However, this is dictated by the plan under the contract. A PPO contract often requires the dentist to provide diagnosis and treatment planning, which are among the most important procedures performed in any dental office, at no charge. Compensation set by the plan regarding treatment that may be reimbursed for is frequently just above the doctor's overhead expenses with respect to many procedures. This places the emphasis on the volume, not the quality, of care. A specialty referral does not lose the doctor any patients in this case, but since most specialists do not participate in these plans a referral comes with either a long wait or a longer drive. Many PPO contracts contain clauses (called "gag rules") that prohibit the doctor from discussing treatments that the plan does not cover. This would be just fine as long as you want your dentist to ignore any problems you may have that aren't covered by your plan, but then your dentist is working for the managed care company and not for you! Managed care companies recruit dentists into these plans declaring that patients with this coverage will refer others into their practices who receive care using the doctor's established approach. This is usually not true because most patients refer family members and co-workers who are in the same plan. Even if it were true, it would make those patients covered under the managed care contract second class citizens to those patients in the dentist's practice who are proceeding with treatment according to the doctor's fundamental principles. The quality of dental care provided is inevitably comprised under either managed care scheme. In fact, many consumer groups have taken to using the term "mangled care" when referring to these types of plans.
Dr. McArdle is only interested in providing the absolute best quality of care that he possibly can. For this reason and the state of affairs recounted above, it is in your best interest that Dr. McArdle does not participate in any managed care contracts. If you are dissatisfied with your current dental benefits coverage, ask Dr. McArdle about Direct Reimbursement (DR). DR is a superior alternative to conventional dental plans that your employer should know about. If you have questions concerning any of this, please ask Dr. McArdle.
