Posts for tag: dental benefits
While daily news continues the debate regarding health care and medical insurance options, for a variety of reasons, as the calendar is ready to turn to a new page, we get more calls pertaining to dental benefit plan selection, i.e. what some people call “dental insurance."
When an employer has purchased a plan that provides dental coverage for you and/or your entire family, it is usually a great deal for you. You are gaining a benefit that is usually tax free and that helps pay for dental services at a reduced cost for you. In most cases, that qualifies as a “no brainer” – take it!
However, when you either are asked to pay for the company plan yourself or you decide to shop for coverage on your own, that may be a very different situation. I would suggest that you then need to be asking a series of focused questions before making a purchase. What’s the difference? Company plans are based on a large number of individuals, many of whom either won’t use the plan or have minimal needs. In that case, those premium dollars help cover the people who have significant issues that involve much more expense. As long as your premium costs are low, you win!
If you are looking to purchase an individual plan, the insuring company can probably assume a few things: You’ll use the plan by having regular visits to your dentist, and that you probably have a history of significant dental expenses (otherwise why would you be looking to purchase the coverage?) Therefore, your premium will probably be significant, and your benefits may well be fairly limited. That’s why you need to ask the following questions:
- How much is the monthly premium?
- Does it just cover you or does it also cover your entire family -- and how is the term “family” defined?
- What is the annual maximum benefit -- either for each person that is covered or for the entire covered “family” if that’s who the plan is for?
- What is the annual deductible and again, is it for each person covered or for the “family”?
- Is it a graduated plan? By that I mean will it provide more benefits and / or higher payments in the second year than the first, etc.?
- Is there a waiting period before you receive any coverage other than preventive or basic services and, if so, how long is it?
- Can you continue to see your current dentist without incurring any financial penalties?
- Is the coverage different for IN network dentists versus OUT of network dentists? (This question is very similar to the previous one, but the answers may be different.) If the coverage IS different, which category does your current dentist fit into?
- What percentages are paid for the following different types of treatment:
- Diagnostic services such as examinations and x-rays?
- Preventive services such as cleanings?
- Minor restorative services such as tooth-colored fillings?
- Major restorative services such as crowns and replacing missing teeth with either fixed bridges, partial dentures, or implants?
- Is there a pre-existing exclusion clause. For instance, if you are already missing a tooth, will the plan cover the replacement costs or deny them based on the fact that you were missing it before the coverage began?
Once you have the answers to those questions, you can begin to make an informed decision about whether or not you want to purchase the plan. Some of the variables may be how great is your risk of needing significant treatment and will that type of treatment be covered? If you are a current patient of ours, you could ask us for some approximate fees for treatment you are considering and compare those fees to the coverage you would receive. If you aren’t, you could ask your existing dentist. If you have generally gone to your dentist every six months, and you’ve had very few problems, then compare the cost of those two visits to what your premium would be and how much the deductible is. Your decision might suddenly be very obvious!
In general I’ve advised most people to investigate a health savings account (HSA) if they qualify for it. Most of the time if they deposit the amount of the premiums in it, over the years they are likely to come out way ahead. Even if they don’t qualify for an HSA, most people could probably open a “dental savings account” and still be ahead.
Of course every situation is different, but asking the right questions may save you a large amount of money and hassle. Good luck with the process. HAPPY 2019!
“Why do I need to go to the dentist every _____?” You can fill in the blank – I hear that blank space filled with words ranging from “6 months”, “year” to leaving it totally blank so the response is actually, “Why do I ever need to go to the dentist?” I think that’s a legitimate question, and I also believe that the answer varies tremendously based on the individual’s health and needs.
First, let me be clear: No one “needs” to go to the dentist. There I said it, and some of my colleagues may come after me for that statement. BUT (and you notice that word is in bold, capital letters), almost all people benefit from going, especially if they want to keep their mouths and the rest of their bodies in good health. While there are probably a few folks who could keep their teeth and stay dentally healthy without ever going to a dentist, the number of those people is very low.
What we really should be discussing are each individual’s desires. Good health, clean and shiny teeth, fresh breath, keeping natural teeth for a lifetime, or simply the ability to eat and enjoy a good meal? There are others who simply don’t seem to really care about these things. For them, there is a further issue – systemic health. If good overall health is important to you, so are regular visits to the dentist. Indeed, even if someone has false teeth, regular visits are important to allow for early detection of possible cancers and other systemic diseases.
Regular visits to the dentist are now considered important enough that some medical policies are paying for people with diabetes to see their dentist four times per year. Those companies do this because there is solid evidence that consistent dental care reduces the incidence of major medical problems! That’s truly a case of dental care potentially saving someone’s life.
So if you are one who wants to keep your mouth and the rest of you healthy and have a bright shiny smile, how often should you visit us? As a first premise, that’s a question to discuss with us -- ask us how often you would benefit from periodic visits. Then ask us for the reasoning behind that answer. Many of us were raised with the idea of seeing our dentist twice a year and brushing our teeth twice a day. I don’t know that either of those ideas is well supported by clinical evidence. There are simply too many other factors.
Consider these factors:
- Do you currently have a high decay rate? (For example, do you need fillings more than once per year?)
- Do you have a mouth full of old fillings and / or crowns? (This is a good clue to your historic susceptibility to dental disease.)
- Have you had or do you currently have some form of gum disease? If so, how severe is it, is there bone damage, and how easily do your gums bleed?
- What is your systemic health status?
- Do you have diabetes or other inflammatory-related diseases such as heart disease?
- If you have any of these diseases, how well controlled are they?
- Has your medical doctor recommended you see a dentist? (This might happen because you are going to have surgery soon or because your physician suspects you have active dental problems.)
- Are you pregnant? (If so, you being in good dental health is really important for the health of your baby.)
After all those factors are carefully weighed, what is the final answer? Most people do come for a visit two times a year. That may be as much because they have a dental benefit plan that pays for two visits a year as for any other reason. We have some clients in our practice that we plan to see about once a year, and sometimes that gets stretched out to once every eighteen months. I’m comfortable with that interval when they have a very low incidence of dental problems, are in good systemic health, and take consistently excellent care of their mouths. On the other end of that spectrum are the people who don’t take very good care of their mouths, whether they are systemically healthy or not. We want to see those people every three or four months, and sometimes as frequently as every two months. That allows us to help them maintain a better dental condition than they have been able to do for themselves.
We also have a few of our clients that are healthy, both dentally and systemically, and simply want to come in every two to three months because they want stains cleaned off their teeth. Some people really love how their mouth feels after having their teeth cleaned.
So talk with us and let us work it out together! Together, we can determine what is right for you!
“I don’t want any x-rays today.” and “Do you have to take x-rays today?” are probably the two most common comments or questions we hear every week. I don’t hear them very often from our existing patients because they know our rationale about taking x-rays, but I hear it a lot from new patients coming into our practice. When we discuss those concerns, most fall into three broad categories: cost, need, and radiation exposure.
In 2012, the American Dental Association revised their guidelines for taking x-ray films, working with the U.S. government’s Federal Drug Administration. They noted that multiple factors impacted when x-ray films should be taken: the patient’s age, symptoms, history (amount of previous problems, etc.), and the frequency of that person’s care, i.e., how often do they visit a dentist. For new patient adults, the recommendation was for either a panoramic film and bite-wing radiographs (cavity-detecting x-ray films) OR a full mouth series of films (about eighteen individual small films). For new patient children, the recommendation varied widely based almost completely on the child’s age and existing conditions. For current patients, the recommendations centered on problem-focused films, if necessary, and bite-wing films every six to thirty-six months based on the variables previously noted.
We all acknowledge that x-ray radiation is potentially harmful, although the amount of exposure to a person from dental films is very small compared to almost any other medical exposure. Indeed, we are exposed to far more radiation working outside all day than we are from dental films, but never-the-less, the more we can reduce that exposure the better.
The other area that has always intrigued me is the differences between what the ADA recommends and what the dental benefit industry allows payment for. While I understand that benefit plans attempt to cover an “average” need of the people they cover, those plans vary widely in what they do pay for. Some plans pay for a panoramic film or full mouth series of films as often as every three years while others only allow a single peri-apical film (a film that shows the whole tooth including the root) with a diagnosis of why it was taken. And bite-wing films are often allowed once a year, but not with every plan. My sense is that these plans institute their allowances for a variety of reasons related to marketing and expense control (leading to profit for them), but rarely with the patients’ best interests in mind.
In our practice, we follow the ADA guidelines closely. We take initial films on new patients unless we can get reasonably current films from their previous dentist – then we sometimes don’t need to take any. For our existing patients we almost never take bite-wing films more frequently than once a year, and for most of them it is about once every two years or more. That interval allows us to monitor changes in their teeth and bone levels adequately without more frequent exposure. Then every six to twelve years, we take a new panoramic film or full mouth series so we can evaluate the complete mouth more thoroughly.
So what is the cost? What I’ve learned from asking people is that the cost isn’t nearly as much as many people expect. In our office, single films cost between $22 and $30 each based on many variables while panoramic films range in cost from $95 to $110. Many of our patients tell me that’s nowhere close to what they expected.
I think I’ve already addressed “need” in my previous comments, but let me add that if you wonder why your dentist is recommending taking certain films, talk to her or him about it. You ought to get a clear answer that makes sense to you. If you don’t, then talk more about it. I literally review each person’s history before each of their appointments with us, and based upon that review, I determine what films we should or should not take at that visit. I prescribe it based on their needs and their current and historic circumstances.
As for radiation exposure, there is no question that less is better, but I am always looking at it from a perspective that in business is called “ROI.” That means “return on investment.” By that I mean that I’m always asking myself “Do YOU, as my patient, get a return of important information that allows me to better care for you from your investment of radiation exposure, hassle, and dollars spent?” Only if the answer is yes, do I recommend that we take the films.
I hope this has been helpful. As always, if you have questions, give our office a call, and we can discuss it further with you.
This article originally appeared in Dubuque 365 magazine.