Dental Insurance? Not. Sandy Springs Dental Care

Give me a break.  Dental insurance plans are a business arrangement between the insurance company and an employer.  Unfortunately, the reimbursement and benefit levels are based on carrier and employer business decisions, and not on your need for treatment.  At best, it pays for 2 cleanings and very little after that.  Most plans have a maximum benefit of between $1,000 and $1,500 per year, which is a far cry from what you really need for your oral health care.

These benefits (I use that term loosely) haven’t changed since the 1980’s.[1]  It’s ridiculous to tie your dental provider’s hands with reimbursements that haven’t risen in 35 years while the cost of living has increased dramatically in comparison.  Patients that have major restorative or surgical needs or bite dysfunction cannot afford to delay treatment and spread it over multiple insurance plan years, because their condition may worsen if not treated immediately. And none of the reimbursements take into account the added costs of HIPAA, associated and new technologies.

Like medical insurance, some dental plans do not offer coverage for pre-existing conditions, such as missing teeth. This type of plan would not cover tooth replacement procedures, such as bridges, partial dentures, full dentures or dental implants.  And the continued absence of tooth structure will result in the continued resorption of the jaw bone, further complicating the possibility of restoration.

Many insurance plans will unilaterally apply “alternate benefits” towards your service, such as paying for amalgam fillings rather than tooth-colored composite fillings, or, not covering major restorative services, such as a crowns, inlays, or Cad/Cam restorations.

Because insurance carriers are exempt from anti-trust laws, most dental plans use the terms ‘usual, customary and reasonable’ to determine your insurance benefits.  This term applies to fee manipulation used by dental insurance carriers to set reimbursement levels across the country. The criteria upon which this research is based, including region, time intervals, type of dentist, etc., vary greatly from one insurance carrier to the other.

Unfortunately, under the current system there are very few dental insurance benefits that actually benefit you.

Novy Scheinfeld, DDS, PC

290 Carpenter Drive, 200A

Atlanta, GA 30328

404-256-3620

www.rightsmilecenter.com

info@rightsmilecenter.com

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[1] http://www.bls.gov/opub/mlr/cwc/dental-care-benefits-1995.pdf

Dental Insurance – Dentist Sandy Springs

Whether you need emergency service, or just a routine exam, X-rays and a cleaning, you will find that dental costs have remained relatively flat over the past 30 years.  About 108 million people in the U.S. have no dental insurance, according to the U.S. Department of Health and Human Services. You need to question the value of the investment and be skeptical of what it will provide when they need it.

In many instances paying for dental care when you can afford it is better than paying for dental insurance every month because the plans you could afford as both a small business owner and employed with a part-time job cost more than routine checkups and close to one-third of the annual benefits you’d receive.  Some plans require you to wait a year or more before insurers would pay for major procedures and that it’s highly probable the insurance companies’ networks don’t include your preferred dentist.

Dental insurance premiums vary depending on the number of people the plan covers, the type of plan and the geographic market served, according to Darci Shaw, spokeswoman for Delta Dental Plans Association, which provides dental benefit programs to more than 60 million Americans.[1]  Premiums can be as low as $10 a month for an individual enrolled in an HMO-style insurance plan that restricts patients to a specific dentist in a smaller network, or as much as $50 monthly for a preferred provider organization (PPO)-style plan that allows patients to use their choice of dentists in multiple states. Regardless of the plan type, annual benefits are usually capped at $1,500 a year and cosmetic procedures such as veneers aren't covered.

Dental plans are designed to encourage preventative care and waiting periods and caps on benefits provided help keep premiums low by preventing people from obtaining coverage only when they need major work, then dropping it after the care is completed.   A typical employer-sponsored or consumer plan covers 100 percent of the cost of diagnostic exams, teeth cleanings, X-rays and sealants.  Group plans often pay most of the cost for fillings, root canals, treatment for gum disease and emergency tooth removals upon enrollment.

People who have insurance for dental care go and seek care more often than those who don’t or [who] save the money to cover the cost because oral health problems seldom get better without treatment and dental health problems may be a sign and a cause of disease elsewhere in the body.  Our advice is to make it a priority to know what your plan covers so you can prepare for emergencies and other treatment.  When you’re in real pain, you have to do something.  You need to have that predictability of knowing that if something happens you wouldn’t have to pay twice as much.

If we can be of service, do not hesitate to contact us.

Novy Scheinfeld, DDS, PC

290 Carpenter Drive, 200A

Atlanta, GA 30328

404-256-3620

www.rightsmilecenter.com

info@rightsmilecenter.com

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[1] http://www.angieslist.com/articles/dental-insurance-right-you.htm

Dentist Sandy Springs: Alert - Dental Insurance Code Bundling

Apparently, insurance companies are violating their third party payer agreements to reduce benefits to patients.  In order to use the ADA’s intellectual property, i.e. dental procedure codes, the insurance companies have to agree not to change the code’s nomenclature and description.  However, what is happening is your insurance companies are redefining submitted procedural codes with combined codes that pay you less benefit than you are entitled to.  This is called code bundling, which is designed by your insurance provider to reduce your benefits.

 

HIPAA requires that the procedure code reported on a claim be for effective service rendered on the date of submission.  Unfortunately, there is no effective way for dentists and their patients to enforce this requirement and the result is a misunderstanding created by insurance companies that suggests ‘it’s your dentist’s fault’.

 

The solution is patient push back for the coverage you’re entitled to.  Patients need to question, if not challenge the benefits they have paid for but have been denied.  And patients need to recognize that the contractual relationship is between you  and your insurance provider, not your dentist and your insurance provider.

 

Hopefully, this is a little helpful in understanding the difficulties of receiving your full insurance benefits.   If we can answer any of your concerns, please feel free to contact us.

 

Novy Scheinfeld, DDS, PC

290 Carpenter Drive, 200B

Atlanta (Sandy Springs), GA 30328

404-256-3620

info@rightsmilecenter.com

www.rightsmilecenter.com

 

 

Thank you for all your referrals.  We truly appreciate them.

Information included is not dental or medical advice.  For your specific information

 be sure to consult your dentist.

 

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