Question

What is the difference between a DMO and PPO? How is the practice reimbursed under a DMO?

A Dental Maintenance Organization (DMO) pays the provider a monthly fee (capitation) for each assigned patient. A DMO plan has a set copayment for each procedure performed rather than a percentage of a contracted fee. Also, with a DMO, the patient must receive dental care from an assigned participating provider. That participating provider agrees to accept the contracted fee for each procedure provided as payment in full, only charging the patient the required copayment, if applicable. On the other hand, a PPO has a contracted fee schedule with the provider, and the PPO patient is responsible for any copay and deductible.

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