How to get the most out of your dental insurance

Content:
You have to know the rules of insurance in order to maximize your benefits. Here are some questions to understand about how dental insurance works:

Doesn’t my dental insurance cover everything?Dental insurance isn’t really insurance (defined as a payment to cover the cost of a loss) at all. It actually is a benefit, typically provided by an employer, that helps employees pay for routine dental treatment. The employer decides on the plan based on the amount of the benefit and how much the premium costs per month. Benefit plans are only designed to cover a portion of the total cost of treatment.

But my plan says that my exams and certain other procedures are covered 100 percent.
The key question is 100% of what? This means 100% of the schedule of benefits your employer has chosen. Usually these schedules are less than the fees that dentists actually charge. For example, the insurance company’s schedule of benefits states it pays 100% for cleanings up to the schedule maximum of $50. However, dentists actual fee is $70. The insurance company pays you $50 for the cleaning, and you pay the other $20. This means the actual coverage was 71% not 100%. Welcome to the real world of dental insurance.

So, the dental insurance company sets the payment they pay per procedure, and that’s the UCR.
Many carriers refer to their allowed payments as UCR, which stands for “usual, customary, and
reasonable.” However, as is usually the case with insurance, this does not mean exactly what it seems to mean. UCR is actually a list of payments for treatment set by the insurance company. This payment is related to the cost of the premiums and the geographical area where you live.

Again, these payments are usually meant to help pay for dental treatment, not to cover the entire cost, so this payment is not the recommended fee for all dentists in your area to charge.

You should know:

Deductible $________________
How much you will pay out of pocket before your dental insurance pays for treatment.

Maximum $_______________
How much your plan pays per person, per year.

In-Network vs. Out of Network
Will your plan pay out of network benefits to non-member dentists? What is the difference in payments?

Pre-existing conditions clause?
Some insurance companies use this missing tooth clause as an excuse to deny coverage. If your tooth was missing before you received dental insurance, then they will not pay to replace it.

Waiting periods?
Some plans require a one year wait before they will pay for treatment. This guarantees they will make money on your premium without having to pay out benefits.

Products & Cosmetics not included.
All insurance plans deny payment for electric toothbrushes, adult prescription strength fluoride toothpaste, whitening, and crowns/veneers for appearance improvement only. (You can use your flex or .HSA for this.)

Alternative benefits clause?
To reduce their expenses, most insurance companies will only approve payment for the least expensive treatment option available, even though it’s not the choice you would like. For example, you might like a crown, but your plan will only pay for a large filling. Or you might like a tooth-colored filling and they will pay for silver.

Secondary dental insurance: non-duplication of benefits clause?
The secondary insurance company says the amount they would have paid already has been paid by the first primary insurance company – so they won’t pay anything. If you are in this situation, complain to your employer and consider dropping your secondary insurance.

Pre-Treatment Estimates (PTE)
If you want to know how much your insurance company will pay, then ask us to send a PTE for you. Your insurance will return a written EOB (Estimate of Benefits) showing the payment for each treatment. Insurance takes 2-4 weeks to process this for you. Watch out though, this PTE is not a guarantee, your insurance reserves the right to reduce or deny coverage anyway.

If you have more questions about your dental insurance plan, just give us a call – ask to talk to Jamie, our reigning insurance expert!

JiLL Nesbitt--MBA, Office Manager

Periodontal Disease

The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” When gingivitis is not treated, it can advance to “periodontitis” which means inflammation around the tooth. In periodontitis, gums pull away from the teeth and form “pockets” that are infected. Bacterial toxins and the body’s enzymes fighting the infections actually start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and connective tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.

Sarah Trosell--EFDA, Assistant Team Leader

Cavities...

Your mouth is a busy place. Bacteria are tiny colonies of living organisms that are constantly on the move on your teeth, gums, lips, and tongue. Having bacteria in your mouth is a normal thing. While some of the bacteria can be harmful, most are not and some are even helpful. It’s important to see your dentist before a cavity forms so that the plaque you can’t reach with your toothbrush or floss can be removed.

Sarah Trosell--EFDA, Assistant Team Leader

Congratulations Dr. Pierson!!!

Congratulations to Dr. Pierson and his wife, Kandi. They are the proud new parents to a healthy baby boy. Benjamin Joseph came into the world on January 30, 2008. Ben weighed 8 lbs. 12 oz., and was 22 in long. We wish Dr. Pierson and Kandi the best as they embark on this new journey!

Nikea Bowar--Hygienist

Fluoride

Fluoride is obtained in two forms: Topical and systemic.

• Topical Fluorides strengthen teeth already present in the mouth making them more decay resistant. Topical fluorides include toothpastes, mouthrinses, and professionally applied fluoride therapies
• Systemic fluorides are those that are ingested into the body and become incorporated into the forming tooth structures. Systemic fluoride can also give topical protection because fluoride is present in saliva, which continually bathes the teeth. Systemic fluorides include water fluoridation, or dietary fluoride supplements in the form of tablets, drops or lozenges.

Sarah Trosell...Assistant Team Leader

Happy New Year

Start the new year out right! Get your complete exam from one of our dentists. A complete series of x-rays will be taken and a thorough comprehensive exam will be completed. This is recommended every 5 years to identify any problems before they get too big.

Patty Wilt RDH...Hygiene Team Leader

Basic Brushing Guidlines

• Choose a brush soft, polished bristles and round ends, comfortable in size and shape and allows you to reach every tooth. Hard bristles can injure your gums.
• Brush the outer, inner, and chewing surfaces of the each tooth.
• Use the "toe" of the brush to clean the inside surfaces of the front teeth.
• Brush your tongue to remove bacteria and freshen your breath.
• Brush at least twice a day.

Sara Trosell...EFDA/Assistant Team Leader

Insurance Benefits

As the year comes to an end, so do most insurance benefits. We can help you optimize your insurance benefits for any remaining dental treatment you'd like to complete before the year ends. Call us to discuss your options.

Patty Wilt--RDH, Hygiene Team Leader

Choosing a Dentist?

When finding a potentially new dentist, you can ask to meet him or her to ask questions, discuss your concerns, fears, etc. Consider the following:

• Is appointment schedule convenient?
• Is the office easy to get to?
• Does the office appear clean, neat and orderly?
• Are special arrangements made for handling emergencies outside of office hours?
• Was you medical and dental history recorded?
• Does the dentist explain techniques that will help you prevent dental health problems?

Sarah Trosell...Assistant Team Leader

A Holiday Smile ;)

Gearing up for the holidays? Don't forget your smile. Brighten your smile with take home or our in-office whitening system. To help out your budget, HealthPark is extending a discount for the holidays. Call today to reserve your appointment.

Patty Wilt...Hygienist Team Leader