Isn't my dental office supposed to know my insurance benefits?

As a person who has insurance with a given insurance company, I receive an explanation of benefits within a booklet of benefits that my employer gives to me when I sign up for a plan. In that booklet it breaks down what company covers my medical insurance, my prescription insurance, my eye insurance, and my dental insurance. Often a different company is used for each type of insurance. I personally have four different companies that handle each division of my insurance. Within each insurance plan is sub-groups that further determine how much the insurance will cover for a certain type of claim.

For example, if I pay $4 per month for my dental insurance, my employer might match $4 per month and my monthly premium is then $8 per month. I might be very excited to have this plan because it seems very inexpensive. When I receive my booklet of benefits, I read that due to my low monthly premium, I have a $5,000 deductible to meet before my insurance will cover any dental related procedure. Now, I have a toothache and my plan doesn't sound so good. Because of my low monthly premium, I have a high deductible. When I go to see the dentist I am responsible for the full cost until I reach my $5,000 deductible, at which point, the insurance will then start paying some of the cost of the work.

In another example, say I choose the dental insurance that costs $750 per month. I like this plan because it says that it covers crowns, bridges, veneers, braces, whitening, etc. I just have to go to a certain "in-network" dentist. I call my insurance company to make sure that my dentist is "in-network" to find out that he is!! Now, I have a toothache and I go to the dentist and I don't have any out-of-pocket expenses. But, I decide that I like another dentist better and decide to go to him for another procedure... this dentist is "out-of-network" with my insurance. Now my insurance is saying they will only cover a portion of the expenses & the office is only giving me an estimate. I don't understand why they can't tell me the exact cost that I will owe??

When a dental offices calls insurance companies to determine how much they will cover for your procedures, they often give very vague information. The insurance will tell the office that according to your plan they will cover a yearly maximum, they will say what your deductible is if you have one, they will inform the office of how many cleaning you can have per year and at what frequency. They might say that they may cover 50% of a specific procedure. But as we determined before insurance companies have a fee schedule that determines how much they think a procedure should cost & these are never released. So, for example the insurance may say that they will cover 50% of a filling. (But according to their fee schedule a filling should be amalgam and should only cost $20-for example- so the insurance is actually willing to pay $10. When the filling is done it is actually a tooth-colored filling that cost $50- so now you owe $40). The hard part is that the office doesn't know exactly how much the insurance will cover until the insurance is actually billed for the procedure. And it is illegal (insurance fraud) to bill for a procedure that has not been done, therefore, the office can only call and get an estimate. This is why it is very important for each person to know their individual plan.

My dentist recommended this treatment. Why doesn't my Insurance cover it fully?

Your dental plan may only allow benefits for the least expensive treatment. For example, you have a tooth that is fractured and cannot be restored. In this case, your dentist may recommend an implant and a crown. Your insurance may only cover a bridge. Or your insurance may only be willing to cover an amalgam (silver-colored)filling. If you choose to have the amalgam filling, then your insurance would cover it fully and you would not have any out-of-pocket expenses. However, you will have a very noticeable silver filling and most likely will opt to have it re-done in the future for cosmetic and health reasons. Not to mention, that it is a temporary fix for a tooth that has a huge fracture. Most likely the filling will not hold very long due to the trauma to the tooth and you will end up having an implant and a crown done down the road anyways. If you choose to have your insurance cover the bridge, then you have to use two perfectly healthy teeth that neighbor the fractured tooth to support it. Overtime, this can cause stress on the neighboring healthy teeth and potentially lead to more dental work down the road. If you choose the implant and crown your insurance may cover a portion of the cost, which leads you with more out-of-pocket costs at this time, but potentially will save you from costly procedures down the road. Ultimately, the dentist recommends a treatment that is best for the patient overall. The insurance recommends a treatment that is less expensive for the insurance company and mainly benefits the insurance company. And the patient is left with the decision of which path to choose. It is very frustrating both for the patient and the health care team because often cost is a deciding factor for treatment. But, it is important to remember long-term costs as well in deciding treatment plans with your dentist.

Why Doesn't My Insurance Pay For This?

Every insurance is different. When your employer sits down with an insurance carrier, they determine what plan you are going to be on and the benefits. If you have an individual plan that you purchased on your own, most often there are waiting periods with little reimbursement. There is no regulation as to how insurance companies determine reimbursement levels, resulting in wide fluctuation. Insurance companies are not required to disclose how they determine these fees. Subscribers are generally told that the insurance determines their fees by zip code and that the doctor's fees are higher. (this is not true). The American Dental Association (ADA) has actually investigated how often fee schedules are updated. They found that most often they are only done once in every 10 to 20 years. The exception is Delta Dental, they update their fees yearly to determine the maximum amount in which they will pay.

This answer was written by Priscilla, our office manager. She is responsible for insurance billing and is very knowledgeable on this subject. If you have insurance questions for Priscilla, she is very excited to answer them! Please leave your questions in the comment field and Priscilla will respond.

Medications that can cause a sweet or salty taste:

Medications are listed alphabetically by Generic name - Brand names are listed in parenthesis:

captopril (Capoten), chlorhexadine (Peridex), fluorouracil (Adrucil), lithium (Lithobid, Lithane), nifedipine (Procardia).

Medications that can cause altered taste:

Medications are listed alphabetically by Generic name - Brand names are listed in parenthesis:

amiodarone (Cordarone), Amoxapine (amytal), azathioprine (Imuran), bupropion (Wellbutrin), butorphanol (stadol), cefadroxil (Duracef), cefamandole (mandol), cefpodoxime (vantin), cephalexin (keflex), clompiramine, (anafranil), cyclobenzaprine, (flexeril), desipramine (norpamin), diltiazem (cardizem), didanosine (Videx), dipyridamole (Persantine), Doxazosin (cardura), estazolam(Prosom), Eszopiclone (lunesta), etodolac (lodine), famotidine (pepcid), felbamate (felbatol), flecainide (tambocor), flunisolide (Aerobid), fluphenazine (prolixin), flurazepam (Dalmane), Foscarnet (foscavir), fosinopril (monopril), glipizide (glucotrol), granisteron (kytril), griseofulvin (Fulvicin), Interferon alpha (intron A), Isotretinoin (Accutane) {sour taste}, ketoprofen (orudis), ketorolac (toradol), labetalol (normodyne, trandate), lisinopril (prinivil, zestril), lithium (lithobid, lithane), Loratadine (claritin), metformin (glucophage), minocycline (minocin), misoprostol (cytotec), nifedipine (procardia), oxaprozin (daypro), pergolide (permax), propylthiouracil, pseudoephedrine (sudafed), rimantadine (flumadine), sertraline (zoloft), sumatriptan (imitrex), tolbutamide (tolinase), topiramate (topamax), trazodone (desyrel), triazolam (halcion), trimipramine (surmontil), zidovudine (retrovir), zolpidem (ambien).

Medications that can cause Dry Mouth:

Medications are listed alphabetically by Generic name - Brand names are listed in parenthesis:

Amiloride (Midamor), Amitriptyline (Elavil), Amoxapine (Amytal), Amphetamines (Adderall), Benztropine (cogentin), Bupropion (Wellbutrin), Cetirizine (Zyrtec), Chlorpromazine (Thorazine), clemastine (Tavist), Clomipramine (Anafranil), clonidine (Catapres), clozaprine (Clozaril), cyclizine (Marezine), cyclobenzaprine (Flexeril), Cyproheptadine (Periactin), Desipramine (Norpramin), Diazepam (Valium), Dicycloine (Bentyl), Didanosine (Videx), Doxazosin (Cardura), Doxepin (Sinequan), Duloxetine (Cymbalta), Fluoxetine (Prozac), Fluvoxamine (luvox), Granisetron (Kytril), Guanfacine (tenex), Hyoscyamine (anaspaz), Ibuprofen (Motrin), Imipramine (Tofranil), Interferon alpha (Intron A), Ipratropium (Atrovent), Isotretinoin (Accutane), Ketoprofen (orudis), Ketorolac (toradol), Levodopa (Dopar, Larodopa), Lithium (lithobid, Lithane), Loratadine (Claritin), Methyldopa (Aldomet), Mirtazapine (Remeron), Morphine (MS Contin), Nortriptyline (Pamelor), Olanzapine (Zyprexa), Omeprazole (prilosec), ondansetron (zofran), oxybutynin (ditropan), paroxetine (paxil), pentoxifylline (trental), pphenelzine (nardil), promethazine (phenergan), propafenone (Rythmol), Quetiapine (Seroquel), Risperidone (Risperdal), Rizatriptan (maxalt), Selegiline (Eldepryl), sertraline (zoloft), Sucralfate (Carafate), Terazosin (Hytrin), Tolterodine (Detrol), Topiramate (Topamax), Trazodone (Desyrel), Triazolam (halcion), venlafaxine (effexor)

Medications that can Cause Decreased Taste:

Listed alphabetically by Generic name - Brand name medications are listed in parenthesis:

Diltiazem (Cardizem), Doxorubicin (Adriamycin), enalapril (vasotec), Ethacrynic acid (Edecrin), Etidronate (didronel), Flunisolide (aerobid, nasalide), Fosinopril (Monopril), Ibuprofen (motrin), Imipramine (tofranil), indomethacin (indocin), ketoprofen (orudis), Levodopa (dopar, larodopa), Lisinopril (zestril, prinivil), Methimazole (tapazole), methotrexate (rheumatrex), nifedipine (procardia), nitroglycerin (nitrostat), oxaprozin (daypro), Oxazepam (serax), penicillamine (cuprimine), Pentamidine (pentam), Piperacillin (pipracil), Pirbuterol (maxair), Piroxicam (Feldene), Promethazine (phenergan), Propylthiouracil, Rimantadine (flumadine), terbinafine (Lamisil), Triamterene (dyrenium), Venlafaxine (Effexor), Vincristine (oncovin), zinc nasal gel (zicam)

Medications that can Cause Bitter Taste:

Medications are listed alphabetically by Generic name - Brand names are listed in parenthesis:

Acetazolamide (Diamox), Tylenol (acetaminophen), amphetamines (Adderall), Xanax (alprazolam), carbamazepine (Tegretol), Amiloride (Midamor), Cisplatin (Platinol), Amitriptyline (elavil), Fluorouracil (Adrucil), Ampicillin (Omnipen), Isosorbide Mononitrate (Monoket), Aspirin, Levodopa (dopar, Larodopa), Baclofen (Lioresal)
Metolazone (Zaroxolyn), Carboplatin (Paraplatin), Moricizine (Ethmozine), Cisplatin (Platinol), Procainamide (Procan), Corticosteroids (medrol dose pak), Risperidone (Risperdal), Cyclophosphamide (Cytoxan), Sulindac (Clinoril), Diazoxide (Hyperstat)

Is your food tasting different?

Taste can be impaired by colds, gingivitis, nerve damage, zinc deficiency, and aging. Altered taste sensations cause people to add excess salt or sugar to their diets or to stop eating. If you are one of the two million Americans afflicted by a taste disturbance it may be due to what is in your medicine cabinet.

Some of the most common medications that can cause your food to taste differently may surprise you. Some medications can cause dry mouth, a state called “xerostomia.” In dry mouth little or no saliva is present to help break down food, so the food tastes dry and bland. Common medications that cause this are: anticholinergics (ie: dicyclomine, Atrovent®), antihistamines (ie: diphenhydramine, Claritin®), and tricyclics (amitriptyline, nortriptyline). {We will have a complete list of medications in a future article}

Are you having trouble sleeping at night and are one of millions of people who take Lunesta®? Lunesta® can cause a metallic aftertaste in up to one-third of patients; metallic after taste can also occur in the antibiotics metronidazole (flagyl®) and clarithromycin (biaxin®). Try grape juice after taking the dose to decrease the after-taste on these medications.

If you have high blood pressure you are probably taking an ACE inhibitor, Angiotensin Receptor blocker, or a calcium channel blocker (nifedipine) and these medications can alter your taste buds. ACE inhibitors like captopril or lisinopril can cause a metallic, sweet, or salty taste. Taste buds depend on zinc to work and these medications bind zinc at the taste receptor causing taste disturbances. Angiotensin Receptor blockers (Cozaar®, Hyzaar®) can cause this as well but the incidence is lower.

Dr. McCargar urges patients to discuss medication side effects with their doctors and pharmacists and says never to stop taking a medication unless advised by the prescriber to do so.

Your Questions Answered by Lynn

Q: Which floss is best, waxed or unwaxed?
A: "The best type of floss is truly a personal preference. If contacts between the teeth are tight, an unwaxed floss may snag and leave floss fragments caught in between the teeth. My personal favorite is Glide. Since it has a Teflon coating, it slides between all areas, and if it breaks, it breaks clean, not leaving anything caught between the teeth."

Q: If I swish with Listerine, do I still have to floss?
A: "Yes! Although Listerine does kill bacteria, the product is unable to remove the plaque that is present between the teeth that only floss can remove.

Q: What is the best type of toothbrush on the market?
A: "Any type of toothbrush with soft bristles will be effective in plaque removal. Just avoid any brush with a medium or hard bristle. These types of brushes won't clean as well as soft brushes and can actually cause the gums to recede."

Feel free to leave your question in the comments section!! Lynn will answer your questions in her next segment. Thank you to everyone who submitted a question!

Feel Free to Contact our Office

We have been getting great feedback on our blog. Some things that people are asking about can specifically be answered over the phone by our health care team. We just wanted to take a moment to let you know that if you are a patient or are thinking about becoming a patient of Scottsdale Dental Arts we can answer your questions! Our front dental office is very knowledgeable about insurance and billing. Each person's dental insurance is very different and so it is best to examine the plan on an individual basis. Dr. McCargar specializes in cosmetic dentistry as well as general dentistry. Dr. McCargar treats toothaches, TMJ, tooth abscesses, cavities, etc., and is skilled and experienced in smile makeovers and veneers. His hygiene team has over 15 years of experience in helping patients to prevent cavities. Dr. McCargar is a dentist located in Scottsdale Arizona near to the 101 & Shea. The office is currently accepting new patients. Please contact our office at 480-860-8282 or visit our website at http://www.scottsdaledentalarts.com (or click the title of this article for a direct link) We look forward to hearing from you!

Furthermore, if you have additional dentistry topics that you would like covered on the blog, then please feel free to leave any comments! We are getting great questions & will continue to update the blog to answer these questions! Thanks for your support!

Dentistry in the news...

BASF HOPES TO MARKET CAVITY-INHIBITING PRODUCT

Apr. 2, 2009 08:30 AM
Associated Press

NEW YORK - BASF, the world's largest chemical maker, says it has found a way to prevent cavity-causing bacteria from attacking teeth, a development that could be seen in toothpaste, mouthwash and even candy as early as next year.

Using a microorganism related to those used in yogurt cultures, the Germany-based company said it has engineered a process that clusters harmful bacteria in the mouth before they can bind with sugar and form plaque.

The organism and plaque-causing bacteria are then swallowed as part of the mouth's natural cleaning process.

It's safe to swallow the bacteria, known by the scientific name Streptococcus mutans, because it's regularly found in the mouth and humans already digest it constantly, the company said.

"There is a complex dynamic of bacteria that grow on the teeth," said University of Connecticut Health Center's Jason Tanzer, who studied BASF's results and is presenting his findings at an industry conference Thursday. "They can stick to those surfaces and form a film or they can be swallowed."

As part of his study, Tanzer fed two groups of rats a diet high in sugar, but put BASF's product, known as pro-t-action, in only one group's food.

Tooth decay in the group of rats using pro-t-action was far less pronounced than in the group not using the product, a development that Tanzer said was promising.

"I would be rather optimistic about this product," he said.

The active organism in pro-t-action is effectively dead, meaning it doesn't need to be kept cool - like yogurt - and can be used in a wide array of products like sugar-free candy, gum, toothpaste, and possibly beverages like smoothies. To be effective, the product needs to be in the mouth for about 10 to 15 seconds.

"This is not a replacement" for brushing, said Markus Pompejus, a BASF scientist who helped develop the product. "But it clearly helps to improve your daily oral hygiene."

BASF developed pro-t-action with OrganoBalance, a Berlin-based microbiology company.

More Q & A with Lynn:

Q: I have bad breath. What can I do?
A: "There can be many contributing factors to bad breath such as cavities, diet, or systemic illnesses. However, the main culprit is usually the back of the tongue where odor-causing bacteria are present. Using a tongue scraper or brush will effectively remove the bacteria that causes mouth odors."

Q: What is the most rewarding part of your job?
A: "Being able to help people on a daily basis. I try to encourage every patient in a positive manner without giving the brushing "lecture." No one wants to hear a lecture. I am your partner in reaching and maintaining good oral health and I will always work as a team with you to help you in this lifelong process."

If you have any questions that you would like answered by Lynn feel free to leave a comment & we would be happy to answer!!