Wednesday, August 15, 2012

Cheap Dentistry - is dental insurance the best choice and does having dental insurance cost more in the long run.

Dental care today is quite expensive, many patients are not fortunate to have dental insurance, and the ones that do are comfused by what's available for insurance options.
Dental insurance is a comfusing subject for most patients, HMO, PPO and everything in between can be overwhelming and do they really cover all the necessary treatments your dentist requires.  Most dental insurance plans come with a yearly maximum and a few stipulations that make it difficult to approve the dental treatments required by your dentist.

There are may individual plans that can be purchased and if you're fortunate, your employer offers a plan you can sign up for.  The best person to help you make a dental insurance choice is your dentist.  Once you have a good idea of what treatments you require, you will be able to choose the dental plan that helps you maximize the benefits available to you.  Sure, this may mean you will have to pay for the first dental visit, but in the long run, the savings are realized quickly.

I have found that if you have larger necessary treatments such as crowns and bridges, you will quickly reach the annual allowed maximum and pay a lot out of pocket, if your teeth are healthy and you only require a few cleanings a year and basic treatments such as dental fillings, it might be worth your while to purchase a dental insurance plan.

It's important to also check and confirm that your dentist is a participating provider with the plan you're signing up for.  A dentist makes a contract agreement with the insurance companies to accept their discounted fees, this means that even if your insurance will not pay for certain treatments, the dentist can only charge you the allowed fee based on the fee schedule of that particular insurance company.

These rules vary based on the State you are in.  For example, the state of California states that if your insurance plan does not allow a certain procedure, even if the dentist is participating provider, he is allowed to charge you his usual and customary fees "UCR". 

At this point, you might be more comfused than when you started, but I am hoping you have at least learned a few tricks of the trade and can ask the right questions when you're faced with this decision.

Tuesday, January 17, 2012

Cosmetic Dental Enhancements - Self evaluation for a candidate

A smile is the doorway to the rest of your personality; the smile has a huge impact on self-image and can greatly influence the impression when interacting with other.  Many people feeling self-confident about their smile hold back on smiling because they feel uncomfortable about their smile appearance.

Many dental treatments such as teeth whitening, porcelain veneers and others are available to the public, but how do you know if you’re a good candidate for these treatments.

Before choosing a dentist, it’s important to determine whether you’re a good candidate for cosmetic dental improvements, a list has been compiled to help you make your decision:

  • Stained, yellow or discolored teeth
  • Gaps or spaces between the teeth
  • Crooked teeth, uneven teeth
  • Missing teeth
  • White spots or pitting on the surface of the teeth
  • Uneven chipped edges on the teeth
  • Black metal fillings in the teeth
  • When you smile does your gum show too much (gummy smile?)
  • Is your gum inflamed, red, puffy or sore?
  • Do you feel as if you’re holding back on smiling?
  • Look in the mirror, are the white of your eyes whiter than your teeth
Most often, the cost of cosmetic dental enhancements or the fear of visiting the dentist are the biggest contributors to avoiding the next step in your smile makeover.  It’s important to find and choose a good dentist, study your dental insurance plan in detail and find out what treatments your dental insurance covers.

There are many alternatives available today at an affordable cost, don’t delay your smile enhancement, dental treatments only get worse the longer you wait.  Once you’ve selected a good dentist, together you can evaluate all the options available to you and decide on the best course of action.  After all, you only get one smile and since it’s the doorway to the rest of your personality, you don’t want to keep that door closed; you could be missing out on many great opportunities.

Monday, January 16, 2012

Dental Insurance - HMO or PPO

How does dental Insurance Work?

Understanding the HMO dental insurance plans from a dental office perspective allows you to make better informed decisions regarding your oral health.

If you are fortunate to have your employer offer dental insurance, it's a good idea to accept a dental plan that will help you maintain your oral health by at least getting a regular check up and cleaning.

If you have to purchase dental insurance on your own, it's crucial to understand the details involved in your plan and whether the premiums are worth what you will get back in benefits.

How does HMO work?
An HMO plan usually costs you less out of pocket upfront, but does it really cost less long term.  HMO dental insurance is generally a network of dentists that have agreed to participate in a particular plan.  How a dentist gets paid by HMO insurance is a monthly check received called a "capitation check".  The dentist will be paid anywhere between $5.00 and $20.00 for each patient that has picked his name out of the network book, regardless of whether the patient comes in or not, he does this in agreement that when you actually do come in, the dentist does not get paid for your routine visit (exam, cleaning), so guess what?, the dentist would rather you not come in. If you require a filling, all the dentist will collect is your visit co-pay, generally anywhere between $5.00 and $15.00.

HMO insurance is usually limited on coverage for the type products and treatments that a patient can receive, most do not cover white composite fillings, porcelain crowns, bridge, etc..., if you are in need of those treatments you must pay out of pocket above and beyond what they will cover, which is minimal.  PPO insurance on the other hand allows for many of these treatments and will pay a percentage towards those treatments, while you pay the difference.

Many reputable dentists have stopped accepting HMO insurance due to the variance in coverage and the treatment planning involved, many dentists I've spoken with have confirmed that they find it difficult to treat one patient different than the other based on their coverage, HMO tends to force them to do so.  One dentist told me "I don't want an insurance plan deciding the best course of treatment for my patient". 

You will notice that most dental offices accepting HMO insurance are usually larger and have more than one operating dentists.  HMO insurance does not pay the dental office much, most offices have to hire new graduating dentists and pay them a daily rate and commissions on treatments sold.  Many of the dentists I personally know started out working for these larger offices, all ended up quiting and opening their own practice due to the pressures involved in "selling dentistry". 

Since a dentist gets paid a minimal amount for fillings under an HMO plan, many of the employed dentists are asked to up sell a treatment, a large filling can easily be turned into a crown.  Many treatments that can be done on the same day are turned into multiple visits which allows the dental office to collect your visit co-pay multiple times.  It's too much selling involved, therefore you find many of the private family owned, single dentist operated offices no longer accept HMO insurance. 

If HMO seems to be the more affordable solution for you, do your homework, the best person to ask is your dentist.  In my opinion, if you have excellent oral hygiene, no gum disease issues or your mouth isn't susceptible to cavities, it's not a bad idea to have any dental insurance plan for your routine diagnostic and preventative visits. 

If your teeth require a lot more treatments such crowns, bridges, partials, dentures.  It's probably more affordable in the long run to look at a PPO plan that allows for these types of treatments.  PPO plans cost more but at least you will know you're receiving the treatment you need because the dentist has no reason to up sell anything, they get paid for the work they do.  Having said that, the most important step you can take in all of this is know how to choose a good dentist, have a good understanding of what your dental insurance covers and you will be on your way to making the informed decision on the best dental insurance whether it's HMO or PPO.