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9 Secrets Dental Insurance Companies Don't Want You to Know

February 24th, 2020

 

  1. Who really makes the decisions about the quality of care you receive?

Unlike medical insurance, which started being offered in 1850 by the Franklin Health Insurance Company of Massachusetts, Dental Insurance is a fairly recent phenomenon. Dental insurance was first introduced in California in 1954, and quickly rose in popularity. By the 1970’s, these plans were widely available and usually provided a maximum annual coverage of about $1000 (which is still about the maximum today). The first plans didn’t distinguish between in-network and out-of-network providers. They simply established usual and customary rates for the area, and would pay (typically) 100% of preventative care, 80% of minor dental work (such as fillings) and 50 percent of major work (like crowns, bridges, etc).

Today with the advent of PPO the dental insurance landscape has drastically changed and this is how.  Dental insurance companies are owned by stockholders, equity firms and investment bankers for the purpose of making money.  Unlike medical insurance companies that can run into unlimited liabilities with large claims dental insurance has a cap on the coverage.  We will cover this in number 6 but as a matter of fact annual maximums have hardly changed since 1970. In 1970 the cost of an average new car was $3,542.  The average price today is $33,560. If dental insurance would have kept up with their annual maximums, today they would cover up to $10,000 a year.  Do you see the problem?

Bottom line dental insurance is a very lucrative business.  If they want to make more, the company owners decide to reduce their coverage by limiting the coverage on care you can receive without considering the consequences to you.  It’s not your health they are worrying about.  It’s about how to recover from recent Affordable Care Act losses and their bottom line.

PPO dental insurance plans peaked in 2011 with 65% market share but have been losing ground ever since. As they continue to lower and lower payouts, dentists are dropping out of the networks because they are uncomfortable with the care dictated by the insurance companies and are unable to run a business on the reduced fees. Don’t be surprised if one day the closest dentist in your PPO coverage is in the next state.

It is not uncommon to have dental insurance companies altar the dentist’s treatment plan.  The question becomes “How many years have insurance executives in fancy boardrooms spend in dental school?  What are their qualifications to decide your care?”

  1. Preventive care is controlled by insurance companies and can sometimes be detrimental to your health.

Although experts agree that routine dental exams and regular cleanings may help prevent the incidence of higher-cost treatments such as periodontal surgery, root canals, extractions and fillings and early detection and prevention can minimize your need for more serious dental treatment, insurance companies continue to reduce coverage on those services.  First, they restrict the number of visits you may need to control gum disease.  Some people who have the genetics and lifestyle that contribute to gum disease need to be monitored more closely.  Regardless, insurance companies will only cover a fixed number of visits for gum therapy.  Some limit the visits to as few as one covered appointment per year and restrict some test and x-rays necessary to monitor your progress to once every 5 years. Gum disease has been found to have a correlation with heart attacks and even early onset of Alzheimers.  Can you imagine if you were a cancer survivor or a patient with acute high blood pressure having such restrictions?

Although with the new digital x-rays patients get 1/20th the radiation from an x-ray, insurance coverage refuse to pay for many x-rays that are necessary for the dentist to monitor your dental health.  If something goes undetected until it causes pain, inconvenience or even loss of teeth it doesn’t really matter to the insurance company.  Remember they will only cost them a maximum of $1,000 per year.

I have had patients come into the office with an abscessed tooth two weeks after their 6-month re-care visit.  The reason this happened was insurance companies would not cover adequate x-rays to detect the situation earlier and the patient decided they knew best.

  1. Best care options are frequently denied.

Many times when your dentist is designing a care plan for you, you and he might like to consider optimal care that would include treatments that the insurance company refuses to cover.  Your choice is to do what is best and the insurance company pays nothing or except the care that is covered at 50% or less and live with the inconvenience of coping with less than optimal solutions. I have patients who live with a piece of plastic in their mouths, catching food, causing mouth odor and promoting more dental disease because that was all the insurance company would cover.

  1. Hidden costs with insurance with deductibles.

In 1970 dental insurance companies typically covered 100% of preventive services (with less restrictions than today) and 80 % of all other work with a $50 deductible on and of the 80% covered services.  Today many insurance companies have deductibles as high as $200 but let’s assume it is $50. They may say your preventive is covered at 100% but in the small print it says you must pay the deductible first.  So if a cleaning and x-rays comes to $200, you will pay $50. They will cover a 100% of $150, the remainder after the deductible.  That would be the same as covering your preventative at 75%.  That’s pretty sneaky in my books.

  1. Correcting pre-existing conditions are frequently not covered.

Although dental insurance companies claim to cover major reconstructive dental care like removable partial dentures, dentures, bridges and implants to replace missing teeth.  Be aware of the small clause “pre-existing conditions”.  What this means is if a tooth was missing prior to you being covered the insurance company will NOT pay claims on replacing them. I have had many patients disappointed because they had dreams and aspirations that dental insurance companies would help them finally restore their confidence and a healthy smile, only to find out they had not read the “pre-existing condition” clause.

  1. Waiting periods can jeopardize your health.

Many insurance companies have waiting periods before they will cover certain dental procedures.  This creates an inconvenience minimally or can actually be detrimental to your health if you are encouraged to wait until your care is covered.  I have had a patient wait to get a root canal until her insurance would cover the care.  Ultimately she ended up in the hospital with a life threatening infection and experienced a stroke from the accompanying high fevers.  Waiting periods promote health risks and bigger problems.

  1. Many dental insurance companies create a paperwork barrier to processing your claim.

Supposedly lost coverage requests and Insurance claim denials are a standard operating procedure with most dental insurance companies. It is called “stall as long as you can”.  There are only two things that can happen with that game.  The dentist gives up on collecting the money he earned and cuts his losses.  Or the insurance company gets to keep his earned money a little longer to invest it somewhere else.  When a claim is denied or ignored, it is not uncommon for a dental employee to be left on-hold for over 30 minutes.  If a dental office has 16 unpaid claims you can see the dentist will have to hire someone full time to do nothing but listen to elevator music while trying to recover the money the office has already worked for. Some dental offices have a policy that if they don’t get paid by the insurance company within 60 days you will pay and join them in the fight to get your insurance benefit back.  How well do you like elevator music?

  1. Braces are rarely covered or slightly covered.

Although experts know that crooked teeth not only cause psychological and social problems, crooked teeth promote dental disease.  It just makes sense when teeth are bunched up and growing in different directions that it is difficult if not impossible to keep them clean.  Food trapped between crooked teeth causes tooth decay, gum disease and bad breath.  Many insurance companies dodge the correction of crooked teeth with the pre-existing conditions clause.  Those companies that do cover that correction sometimes pay benefits as low as 20% of the fees, leaving you with the rest.  You will be disappointed if you depend on your dental insurance to straighten your smile.

  1. Cosmetic care is never covered.

In today’s competitive world, jobs, opportunities and even romance can be affected by your smile and how you feel about it.  Insurance companies don’t care.  If you have multiple cavities on front teeth the solution they will pay for is white fillings.  Although white fillings are not bad even the best white fillings microscopically look like sandpaper as compared to tooth enamel.  So imagine what happens when you eat cherry pie or have a glass of red wine.  Yep you’ve got it.  White fillings turn a light shade of pink.  This might work during breast cancer awareness week but for the other 51 weeks it is not so cool.  Also I have seen white filling catch food between the teeth causing tooth decay on adjacent teeth.

I can’t count the times insurance companies have declined to pay for more comprehensive and aesthetic porcelain crowns because they want their customers to experience the consequences of bubble gum and bailing wire dentistry with white filling alternatives.

I had patients who have let insurance companies influence their decision on accepting large white fillings up front come back later regretting their decision. Many of them decided to pay out of pocket to do it right in the first place.  Although they are much happier today they paid a heavy price.  They paid the deductible and co-pay for the fillings and then for the full coverage porcelain crowns.  Plus they had to go through an extra dental procedure.

Solution:  You may want to join others who are reaping the benefits of the Custom Dental VIP Savings Plan.  It is not a dental insurance plan however it does give you 2 FREE COMPLETE exams, ALL NECESSARY x-rays and 2 FREE Cleanings per year and a savings of thousands of dollars on other services. And the BEST News is:

NO yearly Maximums

NO deductibles

NO claim forms

NO pre-authoriztion requirements

NO health questions

NO one will be denied coverage

No waiting periods (immediate eligibility)

FREE consultations

 

All of this for 62 cents a day. With the Custom Dental VIP Savings Plan Investment bankers and equity firms will no longer determine your care. Finally, you and your dentist are in control.

To find out more about the Custom Dental VIP Savings Plan call (469)535-2111.

Gum Disease and Dementia: How Dental Cleanings May Prevent Alzheimer's disease

February 3rd, 2020

The Research

Did you know that the bacteria in your gums may possibly contribute to the development of Alzheimer's disease?

Though it seems that these two topics should be unrelated, new studies have pointed to results that say otherwise. A recent study conducted in 2019 by Science Advances and funded by the pharmaceutical company Cortexyme, demonstrated a correlation between bacteria that cause gum disease and Alheimers. The study found bacteria from gingivitis (called P. Gingivalis) residing in the brains of patients with Alzheimers.

The same bacteria found in our gums when we don't sufficiently brush our teeth, may find its way up to our brain and could lead to an increased risk of Alzheimer’s disease.

 

This bacteria was also found to be associated with the production of amyloid proteins, a dangerous protein that causes neuroinflammation and ultimately neuron death, the mechanism of memory loss.

This is not the first study to find a correlation between gum disease and dementia. A study done by The Chung Shan Medical University Team in 2017 was compiled to determine if there was a relationship between periodontitis (an advanced form of gum disease) and an increased risk of Alzheimer 's.

Although there was no direct causation found, the Chung Shan Team noticed a trend that

"People over the age of 70 that had been living with periodontitis a decade or more were 70% more likely than people without periodontitis to develop Alzheimer’s.”

This study also noted that there was an increased amount of inflammation in the bodies of patients who suffered from chronic periodontitis (gum disease) and that inflammation in general may play a vital role in the development of Alzheimers.

The first study to discover a correlation between gum disease and Alzheimers was initiated by the University of Central Lancashire School of Medicine and Dentistry in 2016. The school was provided donated brain samples from Brains for Dementia Research in order to expedite Alzheimer's research. They meticulously studied the brains of dementia patients compared to those without dementia, and noticed a significantly higher presence of the P. Gingivalis bacteria in the brains of patients with dementia.

Before this study, the only bacteria and viruses that had been correlated with dementia were those from the Herpes simplex Type 1 and other different strains of bacteria, therefore this was a significant discovery. Dr. Sim K. Singhrao, a Senior Research Fellow at the University of Central Lancashire stated:

“We are working on the theory that when the brain is repeatedly exposed to bacteria and/or their debris from our gums, subsequent immune responses may lead to nerve cell death and possibly memory loss. Thus, continued visits to dental hygiene professionals throughout one’s life may be more important than currently envisaged with inferences for health outside of the mouth only.”

Finding P. Gingivalis in our blood stream may signal as a marker and risk factor for developing dementia in the future.

How to Prevent Gum Disease

So how can we prevent gum disease and the potentially dangerous bacteria that comes with it? It’s easy.

  • Brush your teeth for a minimum of two minutes (put on a timer!) twice a day. Do not forget to brush your gum line.
  • Floss twice a day as this eradicates all the stubborn bacteria and the plaque that are most responsible for gum disease.
  • Keep up with our yearly or quarterly hygiene cleanings. Your hygienist can detect the progression of gingivitis early on and ensure that it does not advance to periodontitis. If periodontitis is already present then it is especially important to keep the bacteria that has congregated underneath your gums to a minimum even though it is irreversible.
  • Invest in yourself and buy an electric toothbrush. Many studies have shown that electric toothbrushes remove more bacteria and plaque than manual toothbrushes.
  • Use natural mouthwash. Studies have also shown a lower incidence of gum disease with those who use mouthwash daily.
  • Stay away from smoking and tobacco. Smoking can expedite the progression of gum disease and eventually cause oral cancer.
  • Be more conscious about your sugar intake. Reducing sugar and drinking more fluids can dramatically reduce the sugar loving bacteria from forming.

If you notice that your gums have been consistently inflamed, swollen, painful, and bleeding please make an appointment with Dr. Gates or Dr. Kasali as soon as possible. Other signs of gum disease may be persistent bad breath, receding gums, and loose or separating teeth.

Although there has not been direct causation found between gum disease and Alzheimer's, studies are continuing to reveal that dental health and brain health are much more interconnected than we presume. In conclusion this data points to how paramount dental health’s role is in the picture of our overall quality of life

What is the Average Cost of a Dental Implant?

August 27th, 2019

The average range for a single dental implant can be anywhere from $1,000 to $4,000 depending on where you live and your oral needs.
The average range for an entire dental implant procedure could be anywhere from $1,500 to $6,500 depending on where you live and your oral needs. 

In this post we are going to dive into why this range is so widespread and all the factors that go into the cost of this surgical procedure.

The Cost of Dental Implants Differ From One Patient to the Next 

When it comes to dental implants,the most common question we get from our patients is how much does a dental implant cost?  Our staff will delightfully let you know that the cost of a dental implant is different for each individual person, depending on your needs. We would prefer to schedule an appointment and take a look at your specific situation in order to give you the best estimate we could possibly give you.

We do not want to inform you incorrectly over the phone especially when this range is so broad! 

As we mentioned before, the dental implant or the "tooth root" of this procedure, can be anywhere between $1,000 to $3,000. But the dental implant is only one piece of the cake.

Image result for dental implantImage by https://www.artofsmilespasadena.com/dental-implant-surgery/

Other costs that should be factored in are the abutment which is usually about $300 to $500, and the crown which is usually $1,000 to $2,000.  Then we will need to determine if your teeth need to be extracted which will be about $100 to $500 for each extraction. Depending on the strength and density of your jaw, bone graft may also be needed to ensure a secure and stable ground for the implant itself. This usually costs $400 to $600.Then there is a matter of your individual insurance and how much they will cover.

According to DeltaDental.com the average cost for a dental implant procedure for McKinney residents with the zip code 75070 is $5,142 to $6,195.

If you don't live in McKinney, click here to find out how much dental implants cost in your area.

Now that we know the average cost in McKinney, I will show you our approximate fees at Custom Dental in McKinney:

Our Approximate Fees: 

Tooth Extraction: $288 

Bone Graft: $488 

Implant: $2015 

Abutment: $480 

Crown: $1,388

Total= Approximately $4,659 for a dental implant procedure at Custom Dental of McKinney.

With our Custom Dental Savings Plan applied (our In House Savings Plan): %20 Off All Fees

Tooth Extraction: $230.40

Bone Graft: $390.40

Implant:$1,612

Abutment: $384

Crown: $1,110.4

Total=$3,727.20 for a Dental Implant Procedure at Custom Dental of McKinney with our Savings Plan.

Our Payment Plan Options

Dental Implants are expensive but life changing, therefore, we want to make sure that as many patients as possible are able to afford them. We offer financing through third parties such as Care Credit and Proceed Finance which can turn an overwhelming number into completely doable and small monthly payments. Click here to learn more about our third party payment plans and even apply today!

What makes dental implants so expensive? 

Dental implants are the absolute best replacement for failing and missing teeth with a 98% success rate in a span of ten years. The type of metal (titanium or zirconium) that is placed in your jaw integrates thoroughly into your jaw bone halting bone decay and muscle atrophy, preventing and solving the “sunken in” and aged appearance.

Placing a dental implant is also an extremely technical surgical procedure that should only be done by an experienced dentist and implantologist, oral surgeon, or prosthodontist. The angle of the implant entering into your bone must be executed flawlessly and as we have discussed there are many other parts involved. This is not like a filling procedure where you are finished the same day. Your bone and gums are exposed and take months to be completely healed. There is a process that must be followed and your healing must be analyzed. Here is what that process looks like at Custom Dental in McKinney:

  1. First Appointment: Exam, Consultation, and X-Rays- This is the initial appointment where our dental assistants will take you to our 3D Imaging Panorama machine where we will analyze a detailed 3D image of your entire jaw.We will assess for infection, how much bone decay is present, the quality of your bone and if it is strong enough to hold a dental implant, and if there are any abscesses or teeth that must be removed. 
  2. Second Appointment: Implant Placement- Your next appointment, the implant itself will be properly placed into your jaw bone at the exact depth it needs to be for ultimate success. Once this implant is placed, a temporary tooth will be placed on top so you will not be leaving our practice without a tooth. The next appointment will usually be in 3-6 months depending on how much healing time you need and for the implant to integrate into your bone.
  3. Third Appointment: Abutment Placement- Now that your gum and bone has fully healed we can screw the abutment into your implant to make it permanent. Another temporary crown may be placed if it has not come in from the lab yet.
  4. Final Appointment: Permanent Crown Placement- We will remove your temporary crown and finally place the permanent beautiful crown on top! 

Your implant is now complete and you have a beautiful gleaming tooth (or an entire new smile) to show off to the world!

 

 

 

 

Citations: https://www.deltadental.com/us/en/cost-estimator-results.html

https://www.spiritdental.com/blog/individuals/the-cost-of-dental-implants-broken-down&highlight=WyJicmlkZ2UiXQ==

Why Implants May be a Better Option than Crowns and Bridges

July 26th, 2019

Unfortunately, the two most common routes that people decide to take to address their missing and failing teeth are dentures or bridges. These are usually the most economic decision and this is why they are chosen initially. Implants, though more expensive, have become more commonplace and like all things in the market the price adjusts downward.

Image result for dentures and bridges

Today there is a lesser gap in the affordability of dental implants than one might think. 

Once you evaluate all your options it is important to note the drastic difference that implants have between dentures and bridges and why are they absolute worth the higher price. Dental implants are the ONLY permanent solution, working successfully 98% of the time after ten years, which cannot be said for dentures or bridges. Furthermore, many of the people that are looking for a satisfactory solution to their missing or failing teeth have already tried and bridges before they ended up visiting our office.

As a result, we help people who feel like this is their last and final chance to make things normal for them.  A huge goal at our practice, is to educate people EARLY before they are shocked to realize the dissatisfaction and issues that bridges and dentures may cause.What I tell all my patients about dentures: Many patients come to me initially only seeking interest in dentures. I always want to set realistic expectations with dentures so that patients know exactly what they are getting into so I tell them this story:

The best a denture will ever be is a wooden peg.

Think back to the Civil War days- when a soldier lost a limb the best prosthetic they could offer was a wooden leg and some crutches. Actually in this same era, if you had missing teeth, and you were lucky you would get dentures as well. Let’s fast forward to the future and take note of the differences. We have far surpassed the technology of a wooden peg and now offer titanium articulated joints that will take the place of what’s missing and what’s even more amazing is that many affected people do not let a missing limb stop them from remaining athletic and they may even have an advantage. This is the same for dental implants. They are the premium replacement and are built for the long run. 

Image result for wooden prosthetic leg

  • They often slip creating challenges for eating and talking, making it very obvious that they have dentures. This can cause many insecurities. 
  • When you are eating certain foods this can cause pain when biting down.
  • The problems associated with the taste and ease of use of denture pastes and creams can be awful; a minty flavor does not guarantee a refreshing taste.   

At our practice, the complaints of our patients are certainly taken very seriously. The concerns we have not only coming from wanting our patients satisfied and confident in their smile, but also concerns with the adverse health effects of dentures. From a medical professional’s standpoint these can be very problematic and include:

  • Deteriorating bone quantity and density which cannot be corrected. 
  • Atrophy of the muscles that are unused.
  • Restriction of blood flow to the mouth which can lead to even further complications.

Before I explain further, let’s do an experiment to demonstrate the impact blood flow has on gum tissue, specifically how it can be impeded by dentures, causing accelerated bone deterioration. Take your finger and press it into the back of your hand and lift it up after ten seconds. What do you notice? You will likely see for a short amount of time, a white off color area in the shape of your fingertip.  Why is there? Because you have restricted the blood flow to those areas. This is exactly what happens with dentures and partials, they restrict blood flow!

A healthy flow of blood can be compared to a luscious river providing water and nutrients to the land around it. If water flow is impeded the land around it begins to deteriorate and wither away.

Except the restriction of blood flow is now causing your muscles to break down and your bone to wither away causing an older more “sunken in” look. Cigarettes can also restrict blood flow to the mouth in an even greater degree. This is ultimately why dentures and partial bridges do not work. They actually create further tooth, bone and muscle loss causing a vicious cycle and accelerating the aging process. 

My goal is that each and every patient gets the solution that is best for them but that they are also aware of all of their options and the reality of the situation.

At the end of the day, I want you to go home extremely happy with your results and it is my job to inform you of all the pros and cons.

 

Picture citations: https://www.offislanddental.com/service/dental-bridge-vs-dentures/

https://www.1stdibs.com/furniture/folk-art/primitives/late-19th-century-wooden-prosthetic-leg/id-f_4259463/

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