Thursday, January 24, 2019

Is your dental insurance company ripping you off ?


     I tell all my patients that healthy mouth is a very important part of their overall good health. And we all want an attractive, confident smile. This is why dental insurance is such a highly prized benefit. Insurance can help you get the care you and your family need.
      Frequently, however, the benefits you receive don’t match up with what was promised to you. Your plan may pay a smaller portion of the cost than you think it should, or maybe they reject paying for a particular type of treatment. Of course, the insurance company’s top priority is not helping you get the care you need, it is making money. And the less care you get, the more money they make.
     We’ve all noticed this same disturbing trend with our medical and prescription coverage, where rising premiums, plan limitations and sky high deductibles have left us all responsible for more and more of the cost. Dental plans use some of these same methods to make sure they pay as little as possible.
       The following deceptive practices are not new, but they’ve become much more prevalent in the past few years. Dental insurance companies have spent years stacking the deck in their favor, and these are a few of the ways they do it.

1) Artificially low annual maximums.
     Back in the 1970’s, dental plans had annual maximums of $1,500. That was the most they would pay towards your care in any one calendar year. Adjusted for inflation, they should be paying roughly $6,000 in today’s dollars. Unfortunately, most dental plans have not raised their annual maximums to reflect inflation. Some have actually LOWERED them.
     You may have been told you have “comprehensive” dental coverage, but if they cut you off at $1,500 in benefits, anything more than routine preventive care will rapidly use up your yearly limit. Does your plan still have an annual maximum of $1,500 or $2,000 per year? If so, you could definitely be justified in calling that a rip-off.

2) The “usual and customary” fee scam. 
     Your dental plan has specific dollar amounts they will reimburse for each dental procedure. They call this list the “usual and customary” fee schedule, implying that it is based on average or typical fees charged by dentists in your area. It isn’t. They don’t  tell you exactly how they calculate these fees, but they always set them much lower than the real costs. When you are required to pay the difference, you might feel like you’re being ripped off. Just remember it is the insurance company ripping you off, not your dentist.
     Fortunately, there is objective, publicly available data for consumers who want to see what the real usual and customary fees are in your area. If you go to www.fairhealthconsumer.org you can search any dental (or medical) procedure and see the average fees, broken out by zip code anywhere in the U.S.A.  If you compare these real fees to your insurance company’s lowball “usual and customary” fees, you will see how wide the gap is between them.

3) Frequency limitations. 
     Human beings are individuals. You are an individual. Your dental needs aren’t the same as everyone else’s, but your insurance company probably acts as though they are. Imagine if you had a heart attack, and your medical insurance refused to pay for your care because you had a previous heart attack last year?  Outrageous, you say?
     Unfortunately, dental benefit companies do this kind of thing all the time.  Whether you need treatment for periodontal disease, tooth decay, TMJ disfunction, or many other types of restorative care, your benefits can be arbitrarily limited to a certain “frequency” set by the company.  If you break a tooth that had a filling done a year or two ago, your insurance company will probably refuse to cover the treatment because they say it is “too soon” for the tooth to be fixed again.
     This is just one example of a frequency limitation. There are many others. The insurance company is shifting costs onto the you, patient, instead of reimbursing appropriately. Yep, that’s a rip off.

4) “Preferred provider” networks. 
     Some dental plans maintain networks of “preferred providers”, and encourage you to see only the doctors in that network. Nothing wrong with that. You might assume that dentists get on this “preferred” list because of a higher standard of quality, experience or professional excellence. This isn’t the case. Dentists get on the “preferred” list by agreeing to accept lower fees than normal. Sometimes far lower. Can dentists participate in these networks and still provide good care? Absolutely, they can. And they often do. But it makes it much more difficult.  And it doesn’t help you to have the insurance company’s bureaucrats looking over your dentist’s shoulder, second guessing decisions about your care.
      The important question is : Are you given the choice to see any dentist you want?   Or are you required to see only dentists in their network? Some plans offer only in-network coverage, and pay you nothing (literally, zero) if you choose a doctor or treatment option that isn’t on their list.  Of course, that doesn’t stop them from collecting your premium payment. That is (you guessed it), a rip off.

        Getting these questions answered about your plan is also harder than it should be, of course. The insurance company probably has an 800 number you can call, where you will be kept on hold for a while and then transferred from one flunky to another, none of whom have the information you need, or the authority to resolve any problems.
        You could also get the information from your employer, who makes some of these decisions when they’re designing your plan options. They might not even be aware of some of the more disturbing tricks being used to restrict your care options. If your company is large enough, you might need to speak with someone in the human resources department.
      If you’re given an opportunity to choose among several dental plans, read all the fine print, and don’t just quickly check the box next to the plan with the lowest premium. The cheapest plan might save you some money up front, but it could cost you more down the road. It depends on your particular needs. The more information you have, the better.

     As with all questions about your dental health and treatment, speak to your dentist when questions come up regarding your insurance. We will do our best to help you get the benefits you’re entitled to. More importantly, we can help you get healthy and stay healthy. Whether you have dental insurance or not, regular preventive care is the most cost effective dental treatment you can get.

Wednesday, December 12, 2018

Another reason you should be drinking more water....

As if you even needed one, right?
     By now we all know that drinking enough water is essential for good health,  but you might not have known how important it is for your teeth.  Here are a few ways that drinking water is helping improve your dental health
Image result for crazy  water drinking
1)  Water neutralizes acids. Acids are the mortal enemy of tooth structure, and the bacteria that cause cavities and periodontal disease LOVE an acidic environment.  Many of the things we like to drink are acidic to some degree, and they acidify the entire mouth even after we have finished them.   Soda, coffee, tea, orange juice, wine and (heaven help us) energy drinks like Red Bull are some of the worst offenders.  Water, on the other hand, has a PH of 7.4, which is neutral and non-acidic. When you finish off your meal with a glass of water, you're diluting and neutralizing a good portion of these acids, before they have a chance to harm your teeth.
2)  Saliva production.  Saliva is more than just the stuff that helps us chew and swallow our food. It actually contains lots of Calcium, and also antibodies from our immune system that help fight off bacteria.  A dry mouth is an invitation to tooth decay and gum disease. Staying properly hydrated is critical to maintaining the proper salivary composition and production.
Image result for glamorous close up smile3)  Fluoride.  When I sit down in a restaurant and the server asks me what kind of water I want, I always say "tap water". They might just think I'm too cheap to spring for the bottled water, But tap water contains trace amounts of Fluoride (in most of the country anyway) which strengthens tooth enamel and increases its resistance to acid attack.  Some folks think fluoride is only helpful when we're children, Not true. At any age, fluoridated drinking water is an important weapon in our anti-cavity utility belt.
4)  Water.....the universal cleaning solution. Whenever you want to clean anything, water is probably involved. Whether you want to clean a blackboard, or a car.....or even your teeth, you're not going to get very far without water. When we drink water, the very act of swishing it around our mouths loosens and washes down residual bits of food, decreasing the rate of plaque and tartar formation.
      Your teeth are incredibly valuable. (just ask anyone who has lost a few of theirs) You can help protect them by making sure you drink enough water.  Wouldn't a tall glass of refreshing ice water hit the spot right now?  Best of all.....water is FREE !

Monday, April 2, 2018

SNORING...... It isn't just annoying. It really is a true health hazard.


      Do you or someone you love snore?  It could be more than just an annoyance. It could be a warning sign of obstructive sleep apnea (OSA), a chronic obstructive breathing disorder with long term health consequences.
     We've all heard people snoring loudly (just ask my long suffering wife). It is a loud and penetrating sound. It can be amazing that the snorer himself (or herself) can actually sleep through it. Approximately 45 percent of adults snore and around half that number are habitual snorers. A quarter of those habitual snorers suffer from some degree of Obstructive Sleep Apnea.
      Obstructive sleep apnea happens when the tongue falls back and partly or completely blocks the trachea during sleep. This forces your diaphragm and chest muscles work harder to open the obstructed airway and pull air into the lungs. After a short pause,  breathing often resumes with a loud gasp, snort, or cough. This can happen many times each hour you sleep. You may not sleep well, but you probably won't be aware that this is happening. It can affect your blood pressure or neurological functioning, and can increase your risk for heart attack or stroke.

      If you think you or your partner might be suffering from OSA, please discuss it with your physician or dentist. There are several types of treatment that can be effective depending on the individual.  Continuous Positive Airway Pressure machines (CPAP) are like little oxygen masks that apply just enough pressure to open the blocked airway. They are the most effective treatment, but not everyone can get comfortable sleeping with them. For other people, oral appliances or surgery may solve the problem.
DON'T suffer in silence. Talk to your doctor and get a sleep study done so the condition can be properly diagnosed, and if necessary, treated.

Tuesday, February 21, 2017

The Littlest Patients


Congratulations on the new addition to your family!
     When you bring your new baby home from the hospital, you AND your baby will have plenty of new routines to get used to. One of them should be wiping his/her gums with a soft, wet washcloth at bath time. You could also use a little wet gauze for this purpose, but  I prefer the wash cloth.  You do not need to use any toothpaste yet. Simply wrap the cloth or gauze around your index finger and rub it gently over the gums.  Not only will you be cleaning the food residue away, you will also be getting your child accustomed to having their mouth cleaned. This way, when you need to begin brushing the teeth (around 6 months, when teeth  start erupting into the mouth) there will be no surprises and fewer objections.

     If your child still hasn't gotten her first tooth by her first birthday,  relax – some children don't start getting teeth until 15 to 18 months.  Don’t worry.
     For now, you don't have to worry about flossing. (I know.. I can’t believe I’m saying that)   I recommend starting to floss only when the spaces between the teeth close,  and you can't clean them with a toothbrush.
The American Academy of Pediatrics and the American Academy of Pediatric Dentistry do recommend that you take your child to the dentist by her first birthday, but my own practice, I think any time before the age of two is just fine. Of course, if the pediatrician notes any oral/dental abnormalities during their routine visit, you should bring your child to the dentist as soon as possible.
      In the meantime, at every well-baby visit, your baby's primary healthcare provider should take a look at your baby's teeth (if she has any) and apply fluoride varnish every three to six months, depending on your baby's risk of cavities. (Some kids don’t need this at all)  As with all types of medical care, prevention is the best way to go !


Tuesday, June 14, 2016

Do you or someone you love SNORE?

   
Do you or someone you love snore?  It could be more than just an annoyance. It could be a warning sign of obstructive sleep apnea (OSA), a chronic obstructive breathing disorder with long term health consequences.
     We've all heard people snoring loudly (just ask my long suffering wife). It is a loud and penetrating sound. It can be amazing that the snorer himself (or herself) can actually sleep through it. Approximately 45 percent of adults snore and around half that number are habitual snorers. A quarter of those habitual snorers suffer from some degree of Obstructive Sleep Apnea.
      Obstructive sleep apnea happens when the tongue falls back and partly or completely blocks the trachea during sleep. This forces your diaphragm and chest muscles work harder to open the obstructed airway and pull air into the lungs. After a short pause,  breathing often resumes with a loud gasp, snort, or cough. This can happen many times each hour you sleep. You may not sleep well, but you probably won't be aware that this is happening. It can affect your blood pressure or neurological functioning, and can increase your risk for heart attack or stroke.

      If you think you or your partner might be suffering from OSA, please discuss it with your physician or dentist. There are several types of treatment that can be effective depending on the individual.  Continuous Positive Airway Pressure machines (CPAP) are like little oxygen masks that apply just enough pressure to open the blocked airway. They are the most effective treatment, but not everyone can get comfortable sleeping with them. For other people, oral appliances or surgery may solve the problem.
DON'T suffer in silence. Talk to your doctor and get a sleep study done so the condition can be properly diagnosed, and if necessary, treated.