What is the difference between the fee for service and managed care?

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With each passing day, dental care regulations are changing and so are insurance providers’ models as well. A “fee for service” simply means that an individual is allowed to see any dentists, hospital doctors they wish to see. “Managed care” means a dental insurance plan that manages both the aspects of dental care: quality and cost of medical facilities. Its main aim is to provide insurance coverage to individuals by focusing on dental care management, which produces better results and healthy lives. To understand the difference between both types of reimbursement models, it is important to have detailed knowledge about both models that will help in figuring out the best dental care payment cycle management.

All about managed care and what makes it better?

Managed care refers to that group of insurance plans which are aimed at managing the two aspects of dental care, one is cost and the other is quality. If an individual belongs to managed care that means they will get medical facilities at minimum cost. Its main aim is to provide better patient outcomes by focusing on prevention and dental care management. With such a plan, an insurer needs to sign a contract with some dentists regarding the facilities they provide so that they will be at reduced costs. These dental care providers need to provide dental care facilities at minimum cost. Additionally, the dentists need to fix prices for medical care they provide and also try to reduce the costs by focusing on providing incentives like charging less for generic medicines rather than branded medications.

Some managed care providers provide cashless access for medical services to their patients which gives insurers a deep idea about the performance of dental benefits. It also allows an individual to choose, compare their dental care services and thus avail best of them. The main advantage of managed care is that it provides dental care services to people immediately when they consult with dental care professionals. 

Listed below are some of the benefits of managed care such as:

A managed care organization allows older persons wanting any surgery to choose medical services without paying cash at the preferred network. This allows the individuals to choose the preferred medical center by using a mile app with cashless hospitalization. Additionally, E-cashless also allows an individual as well as their family members to have full visibility on expected cost, the amount that needs to be paid out of pocket, and the amount covered under the policy.

Managed care organizations interact with different dental care providers about the rates of medical services. This way, dental care providers provide medical services at low cost and discounted rates. Also, these plans help to control the various price losses in case of hospitalization. All of these activities also help dental care providers to provide quality services to their patients without worrying about the revenue cycle.

Managed care organizations also interact with all stakeholders so that they can invest in the technology of hospitals for transformation. It also allows all stakeholders to join one platform to improve the access and quality of dental care delivery.

Managed care organizations play an important role in checking trusted and genuine beneficiaries who follow the terms and conditions of the dental care policy. New advanced MCO plans are a combination of professional expertise as well as technology that reduces the risk of fraud and abuse control.

Managed care organizations play an essential role in changing the lives of many dental care industries. With the help of deep knowledge of all stakeholders, an optimistic idea for the future, and leading technology, MCO can bring a revolutionary change in the dental care field.

All about Fee-for-service and its benefits:

Fee-for-service is also known as FFS, is a dental care payment model where dental care professionals are paid as per the number of treatments, procedures, services, and other valuable care they provide to patients. In FFS, medical professionals are paid by insurance companies every time the patients receive any type of medical service. In this case, dental care professionals are paid regardless of whether the services they provide are necessary for the patient or not. It is a traditional mode of payment that provides payment for every medical service separately billed. Dental care professionals favor FFS as they get the payment for every service they deliver as per the professional standards. As per this model, the patient needs to pay the doctor first. In this plan, the cost of dental care services is managed by the dental care providers or third-party payers. The quality of dental care services provided to a patient does not affect the incentives that clinicians will get. However, the disadvantage of FFS is that services are separately billed so the patient needs to pay more for unnecessary services.

The ultimate aim of selecting between fee for service and managed care is to access quality care by knowing the cost of treatment. There is no doubt that with the growth of dental awareness among people, there is an increase in demand in providing quality care to patients thus the dental industry needs to shift its attention to providing the best value-based managed care to their patients.