Dental DMO

[Ava]

How does it work?

Is it worth it?

There's one offered at work. There's no limit in yearly benefits, and it covers orthodontia for kids and adults, routine care, etc. You are limited in your choice of primary dentist, and you can only see an specialist through referral.

Most services are covered, although some , not all, have a 40% copay, which seems reasonable.

The one I need, adult braces, is covered after a $2,000 out of pocket expense. Sounds extremely good.

Do you  any of you have this kind of dental coverage? Is it good?

Thanks for the information.

[kjto1]

How long is the braces program you will be on?  Can you switch providers mid-way through the braces?  What about the cost at the new provider when you no longer have this coverage at the old provider?

[TheOtherMe]

I don't know what a DMO is, but I have dental insurance through the federal government and have had for years.  It's come in handy when I needed my crowns, although there was a limit.  My insurance covers 20% of the limit (which I don't remember), the first year, 40% the 2nd year, etc.  I've had it so long that I am fully covered. 

My annual cleanings and x-rays are free to me.  In this area, I have the option of good dentists, not chains.  When I lived in Colorado, only chains were included as covered providers and I now realize they took me every visit.  Those dentists always found a major issue.  Since I moved here in 2009, I haven't even had a filling.  I now wonder if I really needed those 4 crowns.

[justme]

All dental plans I've seen have a braces cap, so that it doesn't seems odd. Plus you'd really have to research switching Dr's if you're moving. Braces are usually for more than a couple months.

[Ava]

Sept 14, 2015 19:11:26 GMT -5 @southernsusana said:

I only have a dental plan offered for no cost my school district. It does have a $1000 limit and doesn't cover braces.

Cleaning, x-rays, etc. are covered at 100%. I'd say my cost for crowns and stuff like that is around 40% as well, but that is 40% of a negotiated price. Is your 40% of list or negotiated prices?  There is a BIG difference. 

Does yours cover 100% or 40% of adult braces after the $2000 oop expenses? How much are these braces going to cost you?

Understand that dental plans aren't really set up to lose money.  So you are basically paying for most of what you will be getting. The "negotiated price" is the only reason why I would consider dental insurance if I had to pay for it myself.

How much is your premium, by the way?

Oh, and mine isn't a DMO.

There are two other plans; one that covers up to 1k, and it's very basic.

Then there is the regular 1.5k a year that almost every workplace offers. I am enrolled in that one for this year.

But it doesn't cover adult braces.

I am currently paying $10.50 a paycheck for the current plan. The DMO costs more, I think it's around $15 a paycheck.

I need to find what percentage of braces they cover after the oop.

[Ava]

Sept 14, 2015 19:27:17 GMT -5 kjto1 said:

How long is the braces program you will be on?  Can you switch providers mid-way through the braces?  What about the cost at the new provider when you no longer have this coverage at the old provider?

I think it will be around 18 months for me.

I don't know how it would be if I switched providers mid-way.

I'm just wondering if this program is worth it. I was quoted between 5k and 7k for braces a couple of years ago.

[Ava]

Sept 14, 2015 19:32:57 GMT -5 TheOtherMe said:

I don't know what a DMO is, but I have dental insurance through the federal government and have had for years.  It's come in handy when I needed my crowns, although there was a limit.  My insurance covers 20% of the limit (which I don't remember), the first year, 40% the 2nd year, etc.  I've had it so long that I am fully covered. 

My annual cleanings and x-rays are free to me.  In this area, I have the option of good dentists, not chains.  When I lived in Colorado, only chains were included as covered providers and I now realize they took me every visit.  Those dentists always found a major issue.  Since I moved here in 2009, I haven't even had a filling.  I now wonder if I really needed those 4 crowns.

Sounds like you have very good dental insurance.

This is a DMO program, I am trying to understand it, because I also have no idea what a dental DMO is, but it's right there in our benefits summary.

I've heard that you have to be careful with chains. I go to one right now, for cleanings and x rays. They have never found anything major. The only thing the dentist told me, which I already knew, is that I need to see a specialist for braces. So I guess I found an honest one

[Ava]

Sept 14, 2015 19:41:04 GMT -5 justme said:

All dental plans I've seen have a braces cap, so that it doesn't seems odd. Plus you'd really have to research switching Dr's if you're moving. Braces are usually for more than a couple months.

I wonder if they have a cap, though it said it didn't in our website. It's very strange. I've read the information and it sound too good to be true. I will have to call the insurance company and find out about it. There has to be some cost that I'm missing.

[weltschmerz]

Sept 14, 2015 19:32:57 GMT -5 TheOtherMe said:

I don't know what a DMO is, but I have dental insurance through the federal government and have had for years.  It's come in handy when I needed my crowns, although there was a limit.  My insurance covers 20% of the limit (which I don't remember), the first year, 40% the 2nd year, etc.  I've had it so long that I am fully covered. 

My annual cleanings and x-rays are free to me.  In this area, I have the option of good dentists, not chains.  When I lived in Colorado, only chains were included as covered providers and I now realize they took me every visit.  Those dentists always found a major issue.  Since I moved here in 2009, I haven't even had a filling.  I now wonder if I really needed those 4 crowns.

Wouldn't that be like an HMO, but Dental?

[Ava]

www.hr.emory.edu/eu/annualenrollment/dental.html

The benefits offered at my job are basically equal to these for the DMO.

[Mardi Gras Audrey]

The DMO is an HMO, for dental.  They keep rates low by limiting your choice of providers and requiring referrals for specialists visits.  A lot of times the providers they have are the young ones (right out of school) or the not so good ones (They are usually accepting lower payts than cash pay patients or pts wth PPOs).

If you are looking at orthodontia, I would recommend going with a PPO or other plan that lets you have as much choice as possible in providers.  You don't want a crappy provider messing with your teeth.

I am currently in a DMO and there was a very limited list of providers.  Most of the providers that were nearby (We had ~2-3 in the plan in our city... I think we have about 20 general dentists in town) had horrible reviews and it stated that they were pushing patients into treatments they didn't need.  I went to one that was pretty young and he was nice but tried to "sell" some treatments I don't think I needed (Have been to multiple dentists throughout the years and the others have never recommended what he did).  

I am lucky, though (Knock on wood).  My teeth are pretty healthy (No fillings, crowns, etc). Aside from a lot of orthodontia as a kid, the teeth themselves have always been in good shape.  I figured I would save the premium money, as I usually only get the annual cleaning/checkup

[The Walk of the Penguin Mich]

That plan looks a lot like the plan I was on.  You had a limited number of dentists you could go to.  When I got sick, I had to pay OOP for cleanings because I couldn't get back there.

Ava....have you had an ortho consult yet?  Many times, you need other treatment than that of an orthodontist (i.e. an oral surgeon to pull teeth) and that info would be included in your consult.  Those specialists are paid separately, not under your $2000 payment.  

You are talking about leaving next year, and if you have paid $2000 up front for treatment, what happens when you leave half done? I also recommend you go PPO for this and research the providers.

[bean29]

We were in a DMO last year. Two dentists told me I needed a crown, went to my DMO dentist, no cavities, no crowns needed. DD should have had her wisdom teeth pulled, it wasn't necessary till I called my dentist from prior year, and they said well yeah, 3 teeth need to be pulled. Finally they agreed, but then told me they could not schedule b/c they did not have an Oral Surgeon. In fall when they were ready to schedule, DH said, forget it we don't know how qualified this person is. I argued with them about charges for a filling too. They insisted they were correct, so I paid it, I just got an "audit refund" of $25. Every time you go in thru will upsell something to you, there will be out of pocket costs if you are not careful.

We went back to conventional plan this year.

[kjto1]

I would wait with the braces until I was in Florida and with the same Dr for the whole treatment.

[Ava]

Sept 15, 2015 6:02:05 GMT -5 kjto1 said:

I would wait with the braces until I was in Florida and with the same Dr for the whole treatment.

Absolutely. I don't plan to start such an important treatment and leave half-way through.

I'm just trying to understand the difference in the plans to know what's available out there.

The "regular" dental insurance we have does not cover adult orthodontia at all.

But it seems the DMO is very limited and the doctors in the plan are not the best. The other plan means paying the whole treatment out of pocket.

[The Walk of the Penguin Mich]

Sept 15, 2015 6:51:30 GMT -5 Ava said:

Sept 15, 2015 6:02:05 GMT -5 kjto1 said:

I would wait with the braces until I was in Florida and with the same Dr for the whole treatment.

Absolutely. I don't plan to start such an important treatment and leave half-way through.

I'm just trying to understand the difference in the plans to know what's available out there.

The "regular" dental insurance we have does not cover adult orthodontia at all.

But it seems the DMO is very limited and the doctors in the plan are not the best. The other plan means paying the whole treatment out of pocket.

Paying $2000 for possibly lousy service is NOT better than paying full price for good service.  This is one of those cases where you really need to research your provider.  A lousy doctor can do more damage than having crooked teeth.