A primary care dentist (PCD) is responsible for coordinating and integrating dental care for patients insured under a Dental Maintenance Organization (DMO) insurance plan. Patients must obtain a referral from their PCD before seeing a specialist, which can keep costs lower and improve the quality of care. DMOs require patients to select a PCD at the beginning of the policy, and insurance companies expect PCDs to control the use of services to prevent overuse and control costs.
A primary care dentist (PCD) is the primary provider of dental care for a patient insured under a Dental Maintenance Organization (DMO) insurance plan. This dentist is responsible for coordinating and integrating dental care for the patient. The PCD serves as a gateway for dental specialists. Patients insured under this type of dental plan must obtain a referral from their primary care dentist before they can see a specialist. This approach can keep dental costs lower for patients and insurance companies, allowing access to a broader scope of services and better quality care.
Traditionally, dental insurance options were scarce. The most common type of insurance offered was for basic dental maintenance such as cleanings and cavity fillings. Major dental work was often not covered. Only dental policies integrated with medical insurance covered more complex procedures, such as the use of orthodontic appliances. In both cases, however, the insured had direct access to any generalist or specialist dentist simply by calling and making an appointment with a doctor who accepted the type of insurance offering coverage.
As a result of the popularity of the health maintenance organization (HMO) model of requiring the insured to select a single primary care physician who controls access to all other medical specialists and services, access to dental insurance was later organized under the same model. DMOs offer a broader range of covered dental services, but require the insured to select a primary care dentist at the beginning of the policy. Once this selection is made, the insured must first go to their PCD, even if the service they need is provided by a different dentist.
Dentists fall into two categories: generalists and specialists. Generalists provide basic care such as cleanings and fillings. Specialists perform important dental work such as bridges, tooth pulling and braces installation. Primary care dentists can only be generalists. An insured person cannot choose a PCD from the specialist category.
Insurance companies expect a primary care dentist to control the use of services so that insurance costs don’t get out of control. The theory is that if the insured needs to go the extra step and get an independent assessment of the need for the procedure, it will prevent overuse. The PCDs also serve as an integration point, keeping the entire dental record insured from all specialist reports. In theory, this should improve the quality of care, as no dental decision would be made in a vacuum.
Finally, insurance companies argue that this gateway approach to services controls costs, which in turn allows them to offer more comprehensive dental coverage. Some of the disadvantages for the policyholder are the additional time required to obtain the services actually needed and the multiple co-payments that must be made with each additional office visit. A copayment is the immediate contribution that insurers require policyholders to pay each time they pay an office visit.
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