Dental insurance is an interesting issue today, and it’s often a complicated one that confuses many patients. Heck, sometimes it even confuses us! Therefore, I’d like to offer a little clarification on what dental insurance is and isn’t, what it covers and what it doesn’t cover, when it’s worth having and when it’s not, and what you can do to make your life and ours a lot easier, smoother, and more trouble-free when it comes to your dental benefits.
- First and foremost: DENTAL INSURANCE IS NOT LIKE MEDICAL INSURANCE!!!! I really can’t stress this enough. With medical insurance, you pay your copay, and your insurance pretty much covers everything after that unless you go out of network or it’s something unusual. With dental insurance, you typically only get a certain amount of benefits per year, usually $1,000 – $1500. If you’re really lucky and have a great employer, it might be as high as $2,000/year.
- What does “UCR” mean, and is it really what it says? “UCR” stands for “Usual, Customary, and Reasonable” fees. Here’s the problem that most people don’t understand……every single insurance company determines what THEY think UCR should be, it varies by the ZIP code of your doctor/dentist, and not only will insurance companies NOT tell us or you what their UCR fees are, but they also don’t even reveal how they calculate them. Obviously, this makes it much more difficult for us to accurately estimate what your co-pay will be, and unfortunately, it often means you end up with a remaining bill after insurance pays less than we originally expect. The GOOD NEWS is that we have recently updated our practice management software to the newest version, and it has some marvelous features that will help us estimate much more accurately as we input more data. Please be patient with us, though — it is time-consuming to do and will take a little while to have completely set up.
- In-Network vs. Out-of-Network: There is a big misconception out there that – if you go to an out-of-network dentist (assuming you have a PPO and not a DMO) — you will end up paying a lot more out-of-pocket. Here’s the thing – that simply is not necessarily true! Now, sometimes it is, especially on really major kinds of treatments, such as bridges, implants, and the like. But for check-ups and cleanings, fillings, and sometimes even crowns, there may be no more than a $10-20 difference. Ask yourself this simple question: if you are really happy and comfortable with your dentist, isn’t it worth a few extra bucks to keep seeing someone you know and trust, rather than pick a dentist just because they’re “in-network,” even if you may not like them but you save a few bucks?
- “My cleanings are covered 100%, Doc!” Sadly, this is no longer true for everyone. With the current economy, many companies are changing the coverage they offer, and some of those plans don’t even cover 100% of your regular cleaning, EVEN IF you go to an In-network dentist. Sad, but true. It is very important that you keep yourself informed of what you plan covers and doesn’t.
- “But my insurance was SUPPOSED to pay $XXX amount, and you told me wrong!” This is where we are really looking forward to the improvements in our software that should help us calculate the proper amount, but there is an EXTREMELY important fact to remember, which is: we can never give you better than an ESTIMATE of what the insurance will pay. The insurance company itself will tell you the same thing if you call them. Doesn’t even matter if you call and give them the ADA procedure code, our fee…..they STILL will only give you an estimate, NOT a guarantee. I know this can be frustrating, and it is for us, too, because we know it’s never fun getting a bill in the mail after you thought you’d paid all you had to pay.
- The last item for today: please remember that, when it comes down to it, you are responsible for the entire bill. If your insurance doesn’t pay; if your company quit paying the dues and the coverage lapsed, or any of the other possible reasons insurance doesn’t pay or it pays less than expected, you are responsible for paying your bill. We bill the insurance as a courtesy to you.
Of course, this doesn’t even get into all the details of all the different insurance plans. Bear in mind that our software has almost 500 different insurance companies listed, and there are probably close to 1000 different policies. It is impossible for us to know every detail of every plan, although we sure do our best to find out. Your best bet, though, is to know your coverage, too. Ask you Human Resources department to help; they are often a great resource if your insurance company is trying to get out of paying, too.
Yes, dental insurance is complicated. Call us if you have any questions.
If you are one of our patients, please take a few moments to visit our Facebook page. We’ll be adding announcements there, specials (pretty much the same thing as here, but you’re probably on Facebook more frequently, right? 🙂 ), and it’s a neat way to stay connected to what’s happening in our practice. You can even write reviews (yes, we WELCOME reviews!!!), become a FAN, and leave messages about what’s going on in your lives. Having a baby? We’d love to see pictures! Been on vacation? Share! Have your own business? Let us know and we’d be delighted to have you list your business for others to benefit.
And if you’re not currently one of our patients but would like to find out more, you can get information on the practice there, too.
I’ve also added a Widget in the Sidebar that allows you to Bookmark us on Delicious so we’re always easy to find. Don’t you just love the Internet? 🙂
While silver/amalgam fillings are not requested very often in our practice, as most prefer to have fillings that blend in with their natural teeth, they are something that we do when situations warrant, as I discussed in an earlier post.
However, when it comes to the general topic of silver fillings, there are a lot of misconceptions, myths, and outright falsehoods out there. There are groups that CLAIM to have proof of a vast conspiracy by dentists to poison our population by using silver fillings (these are probably the same groups who believe that fluoride is a Russion attempt at mind-control of US citizens so they can take us over – hasn’t happened yet, and the conspiracy has been around for decades.); these groups CLAIM to have scientific proof that the mercury in silver fillings is poison that will lead to an absolutely amazing range of diseases, and that the simple removal of those amalgam fillings will almost magically cure those diseases. And it gets even wilder than that, but unless you’re specifically looking for a good laugh at how crazy these conspiracy theories get, I won’t bore you with all of them.
Let me be perfectly clear about my stance on this issue:
To date, there is absolutely NO, repeat NO CREDIBLE EVIDENCE that the small amounts of mercury present in amalgam/silver fillings causes any disease or disorder whatsoever.
I hope that was clear enough. 🙂
If silver fillings were as bad as the conspiracy theorists claim, then pretty much the whole world would be crazy, as amalgam fillings have been placed by the billions over the last 100+ years. My parents, for example, would have been beset by a myriad of illnesses, as both of them had a mouthful of silver fillings for many decades, and only recently have they been replaced as they’ve slowly worn out. Any strange illnesses in either of them? Nope. Nothing changed after they were taken out 1-by-1 either.
As a rather interesting side note: during my dental school years at the University of North Carolina at Chapel Hill School of Dentistry, I did a 2-month summer exchange at the dental school in Munich, Germany. While there, I was approached by several professors to proof-read some studies that they had translated prior to publishing them in English-language dental journals. Please bear in mind that Germany has pretty much banned amalgam fillings for many years, so it’s not like they are fans of the material. These professors had carried out a study that attempted to find a link between the presence of amalgam filings and a wide range of diseases and disorders; the study had lasted 5-6 years. And what were the results? Simply this:
They were unable to find any positive evidence of a connection between the amalgam fillings and ANY of the list of diseases and disorders that they had listed. Not one.
Kind of interesting coming from professors in a country that has practically banned the material for as long as they have, don’t you think?
This will be the last cosmetic dentistry/Smile Makeover video that I will post for a little while, as I next want to devote some time to showing how destructive “Grinding” of the teeth can be and why it is NOT something that you should take lightly. Bruxism/Parafunction (the general term for both grinding and clenching, which are 2 separate things) can cause major problems for patients, and often in ways not easily visible because it takes time to develop or they’re under the surface. I believe this is an area of dentistry that is often neglected, and it only makes things worse for patients.
With that said, I do hope you enjoy the way we combined different kinds of treatments to achieve a dramatic Smile Makeover for Daniel, as visible in this video.
Don’t forget – if you want to see all of the videos for our practice, check out our YouTube channel: SmilesbyPayet.
Combination Porcelain Veneers and Short-Term Braces
Tonight was the first meeting of 2009 for the Charlotte, NC area CEREC Study Club, which I founded shortly after I took possession of my CEREC 3D CAD/CAM system on December 31st, 2007. (If you’re unfamiliar with the terms, CAD/CAM means “Computer-Aided Design/Computer-Aided Milling.”) It was really a very exciting meeting (ok, most people probably wouldn’t find it really exciting, but we’re a bunch of dentists, after all, who happen to be kind of geeky and like hi-tech tools in our office which happen to provide really awesome results for our patients), as the manufacturer (Sirona USA) just recently released a tremendous new upgrade, the CEREC AC Bluecam, which uses a range of improvements in both hardware and software to drastically increase the system’s speed.
Given the cost of the new unit, and since my CEREC 3D is only 13 months old, I’m not going to be introducing this new version to our office this year. The one we have, the CEREC 3D, is still an excellent system, and we regularly enjoy giving our patients the great experience of single-visit all-ceramic crowns and onlays with it. This means no temporary restorations, no second visit getting numb, no metal, practically no sensitivity afterwards……there’s really no downside.
Along with the new system, Sirona USA is launching another terrific innovation that will also benefit patients, and it’s called CerecConnect. The difference is this: with CEREC, we can create 1-4 units of crowns and/or onlays in a row fairly easily, and even do all of them in 1 visit. However, doing a full arch (all the top or all the bottom teeth) is extremely difficult and typically requires great expertise and advanced training, and it will still usually take 2 visits. In addition, the regular CEREC can’t do things like bridges. With CerecConnect, however, we will still be able to completely eliminate using those gunky impressions that NOONE likes, because we’ll take a digital image of the teeth and then just email it to the lab. How cool is that!?!?
I have a number of recent cases that I plan on posting here in the near future once I get the patient education videos completed. You’ll love what CAD/CAM can do in dentistry, for YOU! The digitization of dentistry is proceeding full-speed ahead, and the benefits are simply tremendous.
Oh, it feels so good to finally be able to announce this, as I’ve been working on it so hard for so many nights after my family has gone to bed, but FINALLY I have begun producing some new Patient Education videos to help explain a number of options that we offer by using pictures of many similar cases.
Over the last 4 years, I have amassed a catalog of about 38,000 digital photographs of the work that we do. You can see my Photography Blog post on the subject of Patient Communication with Digital Photography for more info on how/why we take pictures of our work, but now I’m finally able to turn a lot of those photos into various video formats to highlight problems that many patients have, often without even realizing it, and to let our patients actually see what they can expect once the treatment is completed. It’s really quite exciting! We’re not talking about “stock” photography here, of work that someone else did. EVERY SINGLE ONE of the pictures that you’ll see were taken by Dr. Payet (me), and every completed procedure was performed by Dr. Payet (me) and my Team. (Hope you don’t mind me talking about myself in the 3rd person for a moment there; I was having a Bob Dole flashback after reading some political articles. 🙂
We’ll look forward to showing you these new videos when you come in!
Don’t have any of those videos in Web format quite yet, but keep an eye on our website, Smiles by Payet Dentistry, for them to begin appearing there within the next few weeks. You’ll be able to see and understand so much more easily, I promise!
We’ve actually been a Preferred Provider for Delta Dental Premier for several years now, but we just received confirmation that CIGNA has now processed all the paperwork, and we are officially listed as a Preferred Provider for CIGNA as well. This is great news for the many patients who already receive care with us and who have CIGNA, but for other patients who are seeking a dentist on their list. This will provide some significant savings for anyone whose employer offers them dental insurance through CIGNA.
Of course, I don’t want to miss this opportunity to plug our Smiles by Payet In-House Discount Program, which is a program that we created for our patients with no dental insurance, or who perhaps have dental insurance but it’s a HMO or other plan that won’t allow them to see us, but they value the service and quality we provide and want to keep us as their dentist. Follow the link to our website for more details, or call and talk with Rosie Bonnett, our Front Desk/Patient Care Coordinator, and she can help you get signed up.
Quick Announcement! Check out our website, http://www.SmilesbyPayet.com, to see our new Whitening Specials for Valentine’s Day. Don’t forget that special day is coming up, and you want to look your best.
$100 off our regular Custom Whitening Trays (Normally $350, now $250)
$250 off our amazing Deep Bleaching™ process! (Normally $1195, now $945)
Just in case anyone has tried calling the office or hasn’t seen our website www.SmilesbyPayet.com for updates, our office is closed today due to the snow and icy roads. We are making every effort to contact everyone today, and we anticipate being open again tomorrow, January 21st 2009, so we’ll be working to reschedule everyone promptly.
We do apologize for the inconvenience; as my team members and I all live fairly far from the office, we felt it was too dangerous to make it in. Fortunately, it seems many patients feel the same way, so everything will work out fine. 😉
UPDATE: As usual, the forecast for horrible driving conditions due to multiple inches of snow in Charlotte fell apart. Ah well, at least now we can be sure that we’ll be open on Wednesday for patient care as usual.
We just finished up this case today — doesn’t need much explanation, just that it took about 6 months and the patient was thrilled. 🙂