Bountiful Benefits

As we gear up for the holidays, November and December are also a time to start closing out the current year. It’s satisfying to tie up life’s loose ends while preparing for traditions, celebrations and family. In addition, November hosts one of the most active shopping days of the year, Black Friday.

Many of us are willing to cut our Thanksgiving short, so we can take advantage of some of the best consumer deals money can buy. I propose that we take that one step further and use the savings we earned with these shopping deals to do something responsible for ourselves. Why not treat yourself to the necessary dental work that has been hanging around your neck like the purple and red scarf Aunt Ruthie knitted for you last year? The time is now to take advantage of the premiums that have been paid for and the deductibles that have been reached to avert a dental emergency that could be more painful than the airport crowds this Thanksgiving.

Unlike traditional Thanksgiving dinners, the “Dental Benefits” menu seems to be constantly changing. Many of us (and I definitely include myself) feel like a real turkey trying to decipher our own dental insurance. However, like winterizing our homes in an effort to avoid catastrophes, treating dental needs now and taking advantage of this year’s dental benefits will help to avoid painful emergencies during this holiday season while maximizing your annual benefits.

Turkey with Gravy

I solicited assistance from our Patient Care Coordinators to help breakdownthis insurance mystery, which reminds me of my grandmother’s Cranberry Jell-O Salad that made it to the table every Thanksgiving (What was in that?). Dental insurance can be imagined as our Thanksgiving table cloth and the different types of insurance are our place settings. On this “cloth of protection” are three main types of insurance options: DMO, HMO, PPO and Fee for Service (which is no insurance).

DMO Dental Maintenance Organization: This insurance requires patients to use specific dentists and offers zero coverage to patients choosing to go out of network or off the given list of practitioners. This insurance is extremely restrictive and patients are often assigned to a particular dentist and have set co-pay for all services.

HMO Health Maintenance Organization: Similar to a DMO, HMO’s also offer no out of network benefits and require patients to use the dental professionals that are affiliated with their program. There is a set co-pay for all services, however there are a greater number of dentists participating with HMO insurances allowing the patient to choose doctors from a list that may better fit their preferences.

PPO Preferred Provider Organization: This insurance option allows the patient to choose any dentist in or out of network. There may be a penalty for going outside of those participating doctors i.e. may have a lower percentage of treatment coverage, may be offered a lower maximum, may have to work off a fee schedule, all requiring a greater out of pocket expense. Typically PPO’s offer 100% coverage of preventative treatment which includes two cleanings per year, x-rays one time per year, exams two per year, sealants and fluoride treatments generally for children to age 18 years.

Fee for Service is referencing offices that do not participate with any insurance companies, requiring full payment for all treatment. It is important to verify if an office is a fee for service office if you have been paying for insurance coverage and are expecting some assistance.

Insurance companies each year put a limit on the amount of dental treatment they will cover. This is referred to as the “maximum” and on average range from $1000 to $1500 per year. So for example, if a tooth has deep decay requiring a root canal and a subsequent post and crown, with an insurance coverage of 50%, the yearly maximum met quickly. The fees for cleanings, x-rays and exams are also taken from the maximum coverage thereby depleting the coverage for that year. It is important then to treat dental needs as soon as possible to avoid more invasive procedures that quickly absorb available benefits. Because most insurance companies operate on a calendar year, the dental professionals see November and December as crunch time. It is the time to help patients take advantage of insurance coverage that have been paid for and obtain the 50% (on average) benefit coverage on necessary major dental care while achieving optimum health and diverting holiday emergencies and catastrophes.

If you are aware of treatment needs, have tooth pain or simply need a cleaning, x-rays, and exam, this is the time to be seen by your dentist.  Like spending holidays with the in-laws, completing dental treatment is a necessary evil that will avoid future problems and pay off in the long run.

Side Dishes

Though the first dental insurance plans were presented over 60 years ago, they became most popular in the 1960’s. Shockingly, benefits have remained nearly unchanged since the 1970’s (much like my mother’s red beets at every Thanksgiving table). The maximum benefits were about $1000 in 1970 and have remained about the same but at a higher monthly cost. Statistics prove that dental insurance companies make the least amount of money on clients who use the benefits. “Profits are ascertained from those who pay for the insurance but do not use it.” The CDC also states that 27% of adults have untreated dental caries. Cavities left untreated can lead to root canal treatment needs, which we already know can “gobble” up available coverage. In addition, Gallup states “1 in 3 adults did not visit the dentist in the last 12 months”. In researching dental demographics in our country, it was alarming that the statistics have remained virtually the same from 2008 to 2013 and later. There are dental problems that need to be addressed and it is important to have them treated before they start taking a toll on our total health. I have great faith, if this blog is speaking to you, that you will seek assistance, as the Gallup also reports that the East reports a higher dental visit rate than any of the other regions in the country. Now that’s a blessing!

The Pumpkin Pie

Good health is often taken for granted, like football on Thanksgiving! It’s what we expect. We don’t always think about our health until our daily tasks become compromised and then we are in a bind. Insurance benefits are much like the gizzards of the turkey. They contain great health advantages but sort of gross and overwhelming to identify each part. But the “heart” of the matter is yearly maximums DO NOT rollover so it’s important to use available benefits, especially if deductibles have been met.

At Seidner Dentistry, we offer complimentary benefit evaluations. We will submit your claims and have payments come directly to our office, thereby allowing the patient to pay only their portion of the fee. If you need assistance, let us help you assess your available maximum for 2015, keeping benefits for 2016 available for any potential issues that may arise. Visit your dental office today and take advantage of the Cornucopia of Care available to you and your family!

                  We are thankful to all of you for putting your dental needs in our hands….
We wish you all a Happy Thanksgiving!

By Julia Guerra, RDH, BA

julia@randolphnjdentist.com