Whether you are an employer or an employee, this is for you! Direct Reimbursement offers the best bang for the insurance buck. It is a self directed fund set up by the employer. Here's how it works:
1. Employer decides how much he/she wants to provide per employee for dental benefits each year.
2. The employee knows exactly, up front, the amount they have for dental care each year.
3. Employee keeps their own dentist.
4. Employee and their dentist decide what treatment is best. No pre-determinations. No limitations. No third party involved in any way.
5. Employee pays for the dental care.
6. Employee presents paid receipt to employer.
7. Employer reimburses employee. No fuss- no muss!
This has several obvious advantages over traditional dental insurance.
A. For the employer:
1. Can control this line item of the budget
2. No third parties to negotiate or deal with.
3. Lower cost.
4. Minimal in-house administration.
5. Happier employees.
B. For the employee:
1. Keep your own dentist. Not forced to see a "Participating Dentist".
2. Can spend your allowance on whatever dental care you want - cosmetic, orthodontics, oral surgery, etc.
3. No waiting on pre-determinations or consultant reviews.
4. No waiting for reimbursement from insurance company.
5. Usually higher benefits because employer doesn't have to pay a third party.
So if you are an employer look into providing the best (and cheapest) insurance. Or if you are an employee, share this information with your employer, union rep or HR person. Tell them this is truly a win-win.
The American Dental Association has free information about Direct Reimbursement and assistance in setting it up in your business. Here is the link. Since we feel this is "Simply the Best", our office is happy to assist in any way.
http://www.ada.org/1330.aspx
Thursday, November 4, 2010
Wednesday, November 3, 2010
Part 20: Dental Insurance- The Good, the Bad and the Ugly
Like any insurance, when you need it, it's nice to have. What those of you who have dental insurance need to know is the "cost-benefit ratio". How much is it costing you for your needed benefits versus a larger paycheck. Getting the answer to that question takes some investigation and knowledge about dental insurance. Here is some background information that should be helpful.
Dental insurance benefits differ greatly from health insurance benefits. In 1971, dental insurance benefits were approximately $1,000 per year. In 1995, benefits were only $1,000 to $1,500 per year. As of 2010 only a few policies have $2,000 per year coverage. Figuring a 6% rate of inflation per year, benefits should be over $10,000 per year. Premiums have increased, but benefits have not. Therefore, dental insurance is never a pay-all; it is only meant as an aid.
Many plans tell their participants that they will be covered "up to 80% or up to 100%" but do not clearly specify plan fees, schedule of allowances, annual maximum or limitations. It is more realistic to expect dental insurance to cover 35% to 65% of major services. Remember, the amount a plan pays is primarily determined by how much the employer paid for the plan. You get back only what your employer puts in, less the profits and admistrative costs of the insurance company.
You may receive notification from your insurance company stating that dental fees are "higher than usual and customary". An insurance company surveys a geographic area, calculates and average fee, then takes 80% of that fee and considers it customary. Not suprisingly, the "usual and customary" fee for the same procedure varies from policy to policy. Again, they are in business to make a profit, so controlling pay outs versus premiums is how that is done. If your employer purchased a bare bones policy - a lot more fees are "higher than usual and customary".
Your dental insurance is based upon a contract made between your employer and an insurance company. Should questions arise regarding your dental insurance benefits, it is best for you to contact your employer or insurance company directly. The policy holder has the most influence with the company. Our office will submit any necessary pre-determination of benefits or treatment claim forms. If necessary, we will work with you to finance any charges that are remaining beyond the coverage amount. Remember, unlike some medical bills - dental care won't break the bank.
Professional care is provided to you the patient, and not to an insurance company. Therefore, you are ultimately responsible for the services rendered, and your insurance company is responsible to you the insured.
Lastly, do not let policy limitations determine your dental care. Treatment should be based on an informed decision by you and not an insurance representative. The company will be more concerned as to what is the cheapest treatment, not what is the best treatment for your particular situation.
Dental insurance benefits differ greatly from health insurance benefits. In 1971, dental insurance benefits were approximately $1,000 per year. In 1995, benefits were only $1,000 to $1,500 per year. As of 2010 only a few policies have $2,000 per year coverage. Figuring a 6% rate of inflation per year, benefits should be over $10,000 per year. Premiums have increased, but benefits have not. Therefore, dental insurance is never a pay-all; it is only meant as an aid.
Many plans tell their participants that they will be covered "up to 80% or up to 100%" but do not clearly specify plan fees, schedule of allowances, annual maximum or limitations. It is more realistic to expect dental insurance to cover 35% to 65% of major services. Remember, the amount a plan pays is primarily determined by how much the employer paid for the plan. You get back only what your employer puts in, less the profits and admistrative costs of the insurance company.
You may receive notification from your insurance company stating that dental fees are "higher than usual and customary". An insurance company surveys a geographic area, calculates and average fee, then takes 80% of that fee and considers it customary. Not suprisingly, the "usual and customary" fee for the same procedure varies from policy to policy. Again, they are in business to make a profit, so controlling pay outs versus premiums is how that is done. If your employer purchased a bare bones policy - a lot more fees are "higher than usual and customary".
Your dental insurance is based upon a contract made between your employer and an insurance company. Should questions arise regarding your dental insurance benefits, it is best for you to contact your employer or insurance company directly. The policy holder has the most influence with the company. Our office will submit any necessary pre-determination of benefits or treatment claim forms. If necessary, we will work with you to finance any charges that are remaining beyond the coverage amount. Remember, unlike some medical bills - dental care won't break the bank.
Professional care is provided to you the patient, and not to an insurance company. Therefore, you are ultimately responsible for the services rendered, and your insurance company is responsible to you the insured.
Lastly, do not let policy limitations determine your dental care. Treatment should be based on an informed decision by you and not an insurance representative. The company will be more concerned as to what is the cheapest treatment, not what is the best treatment for your particular situation.
Thursday, October 21, 2010
Part 19: The Halloween Dilemma
Some professional advice for the concerned parent about all that candy at Halloween, Easter,etc. If you'll recall from my first article, sugar intake is what feeds the bacteria that causes dental disease. Each intake allows the bacteria to turn sugar into acid that attacks the enamel and other tissues of the oral cavity. That acid attack lasts for 20-30 minutes with each intake.
What will sound on first blush as crazy, is actually good science. Don't beat youself up about letting your child go trick - or - treating and bringing all that candy home. Same goes for Easter , birthdays, etc. Let them be a normal child. The TRICK is: Let them eat all they want (and more) at one sitting till they are sick of it. Afterwards, have them brush their teeth.
After they've gone to bed, the candy can "disappear" and usually it is not missed later. The TREAT is this allows the child to get dressed up and enjoy Halloween like their friends, eat candy on that and other special occasions but not keep giving their teeth acid baths every 20 minutes for days on end. Thats when the old saying comes true "Eat Candy- Support Your Local Dentist".
If you really want to help us out, you could give out sugar free candy, gum etc. Especially things sweetened with Xylitol . Kids that come to our house get an apple and a toothbrush. They weren't too crazy about it, but their parents made sure our house was on their route for the free toothbrush! I'm not saying you have to go that far, but be creative with what you give out and don't stress - it's supposed to be FUN.
What will sound on first blush as crazy, is actually good science. Don't beat youself up about letting your child go trick - or - treating and bringing all that candy home. Same goes for Easter , birthdays, etc. Let them be a normal child. The TRICK is: Let them eat all they want (and more) at one sitting till they are sick of it. Afterwards, have them brush their teeth.
After they've gone to bed, the candy can "disappear" and usually it is not missed later. The TREAT is this allows the child to get dressed up and enjoy Halloween like their friends, eat candy on that and other special occasions but not keep giving their teeth acid baths every 20 minutes for days on end. Thats when the old saying comes true "Eat Candy- Support Your Local Dentist".
If you really want to help us out, you could give out sugar free candy, gum etc. Especially things sweetened with Xylitol . Kids that come to our house get an apple and a toothbrush. They weren't too crazy about it, but their parents made sure our house was on their route for the free toothbrush! I'm not saying you have to go that far, but be creative with what you give out and don't stress - it's supposed to be FUN.
Thursday, October 14, 2010
Part 18: All Dentists are the Same - Right?
Now, for a word from the sponsor - me. The short answer is NO. Just like everybody else on this planet, we're all different. All licensed dentists went to dental school and passed National Boards, then passed board exams for the state in which they practice. That's where the similarity ends.
After those basic requirements, we are free to practice as we please and only have recently been required to attend minimal continuing education requirements. There is no mechanism to test proficiency or updated practices after receiving our state license. There in lies the rub. How does the public know who's who?
There are clues you can get by inquiry. Is the dentist a member of organized dentistry - the ADA? If so, he or she has ageed to conduct their practice by Principles of Ethics and Code of Conduct that are designed to protect the public. Their local componet has an available Peer Review Committee to resolve complaints - even with insurance companies. The ADA's charge is to protect the public welfare and to police it's membership for unethical practices. Learn more here.
Is the dentist a member of any other dental organizations? Like the Academy of General Dentistry AGD which has strict continuing education requirements and awards Fellowship and Mastership status. The American Academy of Cosmetic Dentistry AACD which is devoted to advances in cosmetic dental treatment and also has requirements for Fellowship status. There are also dental organizations that require nomination for membership. The American College of Dentists ACD, the International College of Dentists ICD, and the American Academy of Dental Practice Administration AADPA are some examples. Membership in dental organizations shows the area of interest the dentist has - if any.
What is the dentist's "reputation"? What is his/her standing in the community? Do they volunteer to make my community better? How long have they been in practice here? Does he/she own their practice or work for an "out of town corporation"? Has there been a high turnover of dentists or staff in that office? Do I know anybody who has had a good experience in that office? Have any complaints or judgements been filed with the State Department of Professional Regulations.
Once you've narrowed the search, then some additional questions need answering. Do they have convient hours? Are they conviently located? Do they see children? What financial arrangements are available if needed? Is the office clean and friendly? How do the staff members get along? Am I treated as an individual or pushed through some system because of my insurance coverage? Is quality or managed care the guiding force in treatment recommendations?
It is our commitment to you, our patients, that we will meet your criteria for an outstanding Dentist, Staff and Office!
After those basic requirements, we are free to practice as we please and only have recently been required to attend minimal continuing education requirements. There is no mechanism to test proficiency or updated practices after receiving our state license. There in lies the rub. How does the public know who's who?
There are clues you can get by inquiry. Is the dentist a member of organized dentistry - the ADA? If so, he or she has ageed to conduct their practice by Principles of Ethics and Code of Conduct that are designed to protect the public. Their local componet has an available Peer Review Committee to resolve complaints - even with insurance companies. The ADA's charge is to protect the public welfare and to police it's membership for unethical practices. Learn more here.
Is the dentist a member of any other dental organizations? Like the Academy of General Dentistry AGD which has strict continuing education requirements and awards Fellowship and Mastership status. The American Academy of Cosmetic Dentistry AACD which is devoted to advances in cosmetic dental treatment and also has requirements for Fellowship status. There are also dental organizations that require nomination for membership. The American College of Dentists ACD, the International College of Dentists ICD, and the American Academy of Dental Practice Administration AADPA are some examples. Membership in dental organizations shows the area of interest the dentist has - if any.
What is the dentist's "reputation"? What is his/her standing in the community? Do they volunteer to make my community better? How long have they been in practice here? Does he/she own their practice or work for an "out of town corporation"? Has there been a high turnover of dentists or staff in that office? Do I know anybody who has had a good experience in that office? Have any complaints or judgements been filed with the State Department of Professional Regulations.
Once you've narrowed the search, then some additional questions need answering. Do they have convient hours? Are they conviently located? Do they see children? What financial arrangements are available if needed? Is the office clean and friendly? How do the staff members get along? Am I treated as an individual or pushed through some system because of my insurance coverage? Is quality or managed care the guiding force in treatment recommendations?
It is our commitment to you, our patients, that we will meet your criteria for an outstanding Dentist, Staff and Office!
Tuesday, July 6, 2010
Part 17: Toothpastes - "Which is the Best?"
Not a day goes by that our staff or myself isn't ask "What toothpaste should I use?". It seems we are all being constantly bombarded by advertisements to buy this or that toothpaste. Well, several factors need to be considered in selecting the most effective toothpaste for you. Just some of the issues to consider are:
1. Are cavities a problem - do I have a high decay rate?
2. Do my gums bleed - do I have periodontal disease?
3. Do I have bad breath - halitosis?
4. Can my teeth be whiter?
5. What if my teeth are sensitive?
6. What if am I allergic to a lot of ingredients?
7. What does it taste like?
8. And what about cost?
As you can see, no one toothpaste can meet all these critieria. So let's start with the basics. Remember Keyes's Circles from Part 1? Getting rid of the bugs is the most important thing for a healthy mouth. That means disrupting the plaque at least once every 24 hours. Toothbrushing is just one of the ways, and toothpaste is just one of the aids. Effective plaque removal doesn't require toothpaste. "Dry" brushing is an OK method if done properly.
Next would come "Home Remedies" : baking soda, salt, and peroxide. They are cheap and effective at killing the bacteria that cause dental disease. Just be cautious with excessive use of peroxide as some studies show a link with precancerous lesions.
After that comes commercial toothpastes. Here a balancing act is important for an "all around" good toothpaste; one that prevents cavities, isn't too abrasive to wear away enamel and cause sensitivy, tastes good, and will keep teeth from turning yellow. So, rather than giving you just one "best", I will let you pick from a list based on their RDA Index (abrasiveness). As you will see, most whitening pastes have a high RDA. That is how they whiten, by being abrasive - so beware! Also look for the ADA Seal of Acceptance as an additional check. But as a good, all around, general toothpaste, the Arm and Hammer line has some safe choices.
Then there are the special situations:
If cavities or a high decay rate is your issue, then a prescription strength fluoride toothpaste is what you should be using. We also recommend this for patients who have had a lot of dental work, especially crowns. It's like cheap insurance. It also comes in a version with a desensitizing agent.
If you already have some begining cavities we might recommend the newest paste with ACP. It can reverse the acid destruction on enamel. This is only available from your dentist.
If bad breath or gum problems are the main issue, we carry two - products in the office for that.
If you have dry mouth syndrome, there are toothpastes that help stimulate saliva flow.
For your kids that are learning to brush - use a toothpaste without fluoride but has xylitol as a sweetner and is bacteriostatic ( kills bugs).
Hopefully, you now can make an informed choice on the "best" toothpaste for you. We are always ready to discuss this with you and answer any questions. Remember, this is a fast changing field. Look for updates.
1. Are cavities a problem - do I have a high decay rate?
2. Do my gums bleed - do I have periodontal disease?
3. Do I have bad breath - halitosis?
4. Can my teeth be whiter?
5. What if my teeth are sensitive?
6. What if am I allergic to a lot of ingredients?
7. What does it taste like?
8. And what about cost?
As you can see, no one toothpaste can meet all these critieria. So let's start with the basics. Remember Keyes's Circles from Part 1? Getting rid of the bugs is the most important thing for a healthy mouth. That means disrupting the plaque at least once every 24 hours. Toothbrushing is just one of the ways, and toothpaste is just one of the aids. Effective plaque removal doesn't require toothpaste. "Dry" brushing is an OK method if done properly.
Next would come "Home Remedies" : baking soda, salt, and peroxide. They are cheap and effective at killing the bacteria that cause dental disease. Just be cautious with excessive use of peroxide as some studies show a link with precancerous lesions.
After that comes commercial toothpastes. Here a balancing act is important for an "all around" good toothpaste; one that prevents cavities, isn't too abrasive to wear away enamel and cause sensitivy, tastes good, and will keep teeth from turning yellow. So, rather than giving you just one "best", I will let you pick from a list based on their RDA Index (abrasiveness). As you will see, most whitening pastes have a high RDA. That is how they whiten, by being abrasive - so beware! Also look for the ADA Seal of Acceptance as an additional check. But as a good, all around, general toothpaste, the Arm and Hammer line has some safe choices.
Then there are the special situations:
If cavities or a high decay rate is your issue, then a prescription strength fluoride toothpaste is what you should be using. We also recommend this for patients who have had a lot of dental work, especially crowns. It's like cheap insurance. It also comes in a version with a desensitizing agent.
If you already have some begining cavities we might recommend the newest paste with ACP. It can reverse the acid destruction on enamel. This is only available from your dentist.
If bad breath or gum problems are the main issue, we carry two - products in the office for that.
If you have dry mouth syndrome, there are toothpastes that help stimulate saliva flow.
For your kids that are learning to brush - use a toothpaste without fluoride but has xylitol as a sweetner and is bacteriostatic ( kills bugs).
Hopefully, you now can make an informed choice on the "best" toothpaste for you. We are always ready to discuss this with you and answer any questions. Remember, this is a fast changing field. Look for updates.
Wednesday, June 30, 2010
Addendum to Prenatal Advice
The California Dental Association has just released new guidlines for pregnant women. This is evidence-based perinatal guidelines developed in conjunction with the American College of Obstetricians and Gynecologists. The article is somewhat lengthy, but full of solid information for the mom to be.
Prenatal Guidelines
Prenatal Guidelines
Thursday, June 17, 2010
Part 16: Baby From Twelve to Thirty Months
A. Dental Visits
The dentist should decide how often each child should be seen. Possibly every 3 to 6 months for self applied fluorides and instructions in preventive dental care. Non threating trips to the dentist pay big dividens if and when some dental work becomes necessary. These trips build familiarity and trust with the dentist and the dental staff. Conversely,a lifetime of fear of the dentist can begin when the child's first visit includes needed emergency dental work. More frequent visits may be necessary to control active dental disease. Pit and fissure sealants may be recommended for susceptable teeth.
B. Oral Hygiene
The dentist or hygienist will teach proper tooth cleaning, demonstrate techniques for holding the child for easier cleaning. Follow up examinations will evaluate the effectiveness of the home care, working with both parent and child to master excellent oral hygiene.
C. Dietary Regime
During the second year baby enjoys gradually shifting to a diet of plain table foods selected from the Food Pyramid. His/her appetite and rate of growth are slower during the second year of life. He/she should be allowed to feed him/herself from a plate with small servings of several items on it. A spoon or the fingers can be used and mike is given for him/her to drink from a "sippy" cup. The following amounts are guides for planning the child's diet:
Milk Group Up to 3-4 cups daily. More than one quart of milk daily is unecessary.
Meat Group 1-2 (2-3oz.) servings daily, including plain chopped meats, fish, and chicken, egg, cheese and peanut butter.
Vegetable/Fruit Group 4-5 (1/2 cup) servings daily, including a wide variety consisting of cooked and raw vegetables, fresh fruit and unsweetened fruit and vegetable juices. A citrus fruit or tomato is needed daily as a source of vitamin C.
Grains 2-3 servings daily. Continuing use of iron- frotified infant cereal is recommended until 18 months of age. Other whole grain, unsweetened cereals may also be used and whole-grain breads, crackers, rice, etc., should be added.
Supplements - Fluoride (if not in the water supply) should be prescribed in the appropriate dosage. Other vitamins and minerals are unnecessary.
Other Foods - Regular use of cookies,candy,cake sugars, soft drinks,sugary fruit drinks, snack foods and chips should be avoided. Read labels! This destroys appetite for meals, risks development of dental caries (cavities) and promotes improper lifelong eating habits. It should be remembered that young children learn and aquire food preferences by example set by parents and other family members. Food and sweets should not be used as rewards or taken away as punishment. Nutritous snacks for optimal dental health should be used throughout toddler and preschool years.Fresh fruit, raw vegetables, yogurt, cheese, meat and peanut butter on whole grain crackers make good snacks.
D. Dental Habits
Continued monitoring of finger and sleeping habits.
E. Arch Development
The dentist will check for any abnormalities in arch development and tooth eruption patterns. Radiographs (X-Rays) of suspected pathology or abnormalities may be recommended.
F. Traumatic Injury
Facial traumatic injuries are more likely at this age and should be seen and treated by the dentist immediately.
G. Fluorides
Fluoride should be continued in prescription if indicated. However fluoride toothpastes should not be used until the child can expectorate (spit) and rinse the toothpaste out of the mouth. Swallowing of fluoridated toothpaste can cause GI upset. There are non-fluoridated, non foaming, xylitol flavored toothpastes on the market that are excellent for children to start with.
This should now have baby on the way to their prettiest smile!
The dentist should decide how often each child should be seen. Possibly every 3 to 6 months for self applied fluorides and instructions in preventive dental care. Non threating trips to the dentist pay big dividens if and when some dental work becomes necessary. These trips build familiarity and trust with the dentist and the dental staff. Conversely,a lifetime of fear of the dentist can begin when the child's first visit includes needed emergency dental work. More frequent visits may be necessary to control active dental disease. Pit and fissure sealants may be recommended for susceptable teeth.
B. Oral Hygiene
The dentist or hygienist will teach proper tooth cleaning, demonstrate techniques for holding the child for easier cleaning. Follow up examinations will evaluate the effectiveness of the home care, working with both parent and child to master excellent oral hygiene.
C. Dietary Regime
During the second year baby enjoys gradually shifting to a diet of plain table foods selected from the Food Pyramid. His/her appetite and rate of growth are slower during the second year of life. He/she should be allowed to feed him/herself from a plate with small servings of several items on it. A spoon or the fingers can be used and mike is given for him/her to drink from a "sippy" cup. The following amounts are guides for planning the child's diet:
Milk Group Up to 3-4 cups daily. More than one quart of milk daily is unecessary.
Meat Group 1-2 (2-3oz.) servings daily, including plain chopped meats, fish, and chicken, egg, cheese and peanut butter.
Vegetable/Fruit Group 4-5 (1/2 cup) servings daily, including a wide variety consisting of cooked and raw vegetables, fresh fruit and unsweetened fruit and vegetable juices. A citrus fruit or tomato is needed daily as a source of vitamin C.
Grains 2-3 servings daily. Continuing use of iron- frotified infant cereal is recommended until 18 months of age. Other whole grain, unsweetened cereals may also be used and whole-grain breads, crackers, rice, etc., should be added.
Supplements - Fluoride (if not in the water supply) should be prescribed in the appropriate dosage. Other vitamins and minerals are unnecessary.
Other Foods - Regular use of cookies,candy,cake sugars, soft drinks,sugary fruit drinks, snack foods and chips should be avoided. Read labels! This destroys appetite for meals, risks development of dental caries (cavities) and promotes improper lifelong eating habits. It should be remembered that young children learn and aquire food preferences by example set by parents and other family members. Food and sweets should not be used as rewards or taken away as punishment. Nutritous snacks for optimal dental health should be used throughout toddler and preschool years.Fresh fruit, raw vegetables, yogurt, cheese, meat and peanut butter on whole grain crackers make good snacks.
D. Dental Habits
Continued monitoring of finger and sleeping habits.
E. Arch Development
The dentist will check for any abnormalities in arch development and tooth eruption patterns. Radiographs (X-Rays) of suspected pathology or abnormalities may be recommended.
F. Traumatic Injury
Facial traumatic injuries are more likely at this age and should be seen and treated by the dentist immediately.
G. Fluorides
Fluoride should be continued in prescription if indicated. However fluoride toothpastes should not be used until the child can expectorate (spit) and rinse the toothpaste out of the mouth. Swallowing of fluoridated toothpaste can cause GI upset. There are non-fluoridated, non foaming, xylitol flavored toothpastes on the market that are excellent for children to start with.
This should now have baby on the way to their prettiest smile!
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