Newsletter content from 11/08/11
INSURANCE: We have had many calls regarding insurance changes the last week or so. We know that many of you are in the open-signup time for your benefit selections. We would like to help you by giving you information that you may find helpful in selecting your dental benefits and understand how that selection affects your bottom line, at least with our office. This is not "new" news, but we have not placed this in writing previously and want to take this opportunity to share this information in this manner so that it may be better understood. Please read over the following details and if you have any further questions, do not hesitate to contact us. PLEASE UNDERSTAND THAT THESE ARE GENERAL STATEMENTS THAT ARE TRUE IN MOST CASES, BUT NOT ALL.
THINGS TO LOOK AT WHEN CHOOSING A PLAN:
We are not IN NETWORK with ANY insurance carrier. If you want to know if your insurance will pay to us, then ask an insurance rep or look into your information packet to see if your insurance will pay to an out-of-network dentist.
We DO accept all insurance policies but we CANNOT give you an accurate idea how well they will pay until they are in our system and have made payments to us (Our software does track the payments from the different insurance plans and uses that data for us to prepare estimates. The later in the plan year the estimate is, the most accurate it is. If you work for a large company where several of your coworkers come to us, we can provide very detailed information pretty early in the year, but we have to collect SOME data regarding payments first.)
Insurance companies will pay based on what is called the UCR (usual, customary, reasonable). In general, the better a plan pays, the more it costs the employer and employee. Less expensive plans generally pay less well. An insurance company will base the UCR and their benefits according to the plan that your employer has agreed to provide to its employees. **BCBS FEDERAL WILL NOT PAY TO US**
PLAN DETAILS - things to look at when choosing a plan
YEARLY COST, ensure that the plan is worth your money. If it is uncommon for you to need much care beyond the cleaning and exam visits (that is, you don't need fillings or crowns often), then you are looking at predictable costs for most years that include your regular routine visits.
If you are a routine 6 month recall it costs you about $300 per year for two exams, two preventive cleanings and one set of bitewing xrays (without insurance). Once every five years we will obtain a full mouth view that adds about $50-100 to your 5-year total.
If you are a perio patient and come every 6 months it costs you about $380, as the perio maintenance cleanings are $40 more than the routine cleanings. So this would be for two exams, two perio maintenance cleanings and one set of bitewings per year. Some patients need three or four perio maintenance cleanings per year, so for each additional beyond two, you are looking at $120 more. (insurances do not usually pay as well for the perio procedures, leaving you a copayment and possibly a deductible, and they many times will not pay for more than two maintenance cleanings per year.)
If you have perio disease that has not been treated or have not been cleaned in a long time, it is not possible to summarize your unique needs here - this information is for the regular and current patients who come in routinely.
YEARLY MAXIMUMS - this is how much your insurance will pay on you per year before they stop paying at all (referred to as "maxing out" the insurance - discussed in great detail in our last newsletter, available if you will scroll down this page).
Most plans have a maximum in the range of $1000 to $2000.
Some plans have what is referred to as a "Low" plan and there is an annual maximum of only $500. That would leave only $200 for additional care beyond two routine recall visits per year. If you ever need major work, it will not be covered.
BREAKDOWN OF BENEFITS - all dental procedures will fall into one of the following categories and benefits will be paid based upon the category.
PREVENTIVE - most pay 100% of UCR (routine cleanings, exams, fluoride treatments*, sealants*, usually xrays) *there is an upper limit in age for coverage of these procedures
BASIC - most pay 80% of UCR (fillings, usually perio procedures, sometimes onlays)
MAJOR - most pay 50%, some higher quality plans pay 80% and some plans have NO major coverage (crowns, dentures, partials)
OTHER DETAILS WORTH MENTIONING:
Some Delta Dental plans (and possibly others) will send payments to YOU and not US. You will need to pay for your visit at the time of service and then keep the check your insurance sends you as reimbursement.
ALL FLOYD MEDICAL CENTER HUMANA PLANS require you to pay $25 for EACH preventive visit. Your $25 copay is due at the time of service.
It is definitely worth mentioning that, although we have ALWAYS been out-of-network for any plans, many of our patients receive really good benefits from their PPO plans. Some PPO plans pay every dollar of the preventive visits. Many pay all but $10-20 of the visit and fewer pay less than half the cost of your visit.
We hope that this helps you make an educated decision when selecting your benefits. We understand that this is confusing to many people for good reason!!
Newsletter content from 08/09/11
INSURANCE Special Situations & PREMEDICATION after joint replacements
INSURANCE MAXIMUMS: Did you realize that your insurance pays up to a maximum amount per coverage period (usually a calendar year) and then is exhausted? Not everyone will experience this situation, but if you need several small procedures or one or two large procedures, you may find yourself "maxed out." Many insurances have "maximums" of $1000, $1500, $2000, or somewhere in between. If you are curious how much of your maximum you have used, you may look at your last EOB (explanation of benefits) and it should be shown on it. We may or may not know how much you have used. If you only receive services from us, then we are able to view this information. However, if you have received services from another dental office (e.g., wisdom tooth removal, root canals, periodontal treatment, etc.), we are not privy to information about those charges and you need to be aware that they take away from your maximum benefit. If you have an appointment with us and you know that you have used a good bit of your insurance benefits so far this year, you may want to check with your insurance company regarding how much benefit you have remaining for this year. We will be happy to help you with this and verify with your insurance if you have enough benefits to cover your appointment costs. Please do not wait until the day of your appointment to check on this. The maximum benefits are per person, so you may have one person in your family "maxed out" and the others are not. This is common with teenagers who have wisdom teeth removed and patients who receive root canal treatment from an endodontist. It is also common for patients who have required crowns, onlays, and other larger-expense services. So, if you have been somewhere else since your last visit - let us know. If you are wondering if you or a dependent is maxed - please ask.
PREMEDICATION REQUIREMENTS: Did you realize that patients who have had a joint replacement (knee, hip, etc) need to take antibiotics orally just prior to dental appointments? We are finding that more and more patients fall into this category and the day of your appointment with us is too late for us to find out. If you have received a joint replacement or a heart valve replacement due to congenital defects, then you must take an antibiotic one hour prior to your dental appointment. All you need to do is to notify us and we will phone in a prescription for the antibiotic you will need to take to whatever pharmacy you choose. You may then pick up your dose of an antibiotic prior to your appointment day so that you are prepared for that day. Please share this information with friends and family, especially those without access to this newsletter. In case you are wondering, these are not "our" rules, they are guidelines set forth by the American Heart Association and listed at the ADA website. We must follow these guidelines and will require premedication prior to treatment. If you would like to read the actual guidelines, please click on the following link -----> http://ada.org/2157.aspx
Not covered under these guidelines are arterial stents. It is our experience that patients with arterial stent placement need premedication for a period of time after placement of the stents. Please ask your cardiologist his or her protocol and if you need us to help you with that, let us know.
Also, understand that there are several conditions which required premedication in the past that NO LONGER REQUIRE premedication. The most common of these was mitral valve prolapse. If you have taken the premedication for MVP or a reason other than joint replacements or congenital heart defects, then you no longer should take a premedication. The only exception is if you have actually HAD infective endocarditis previously - an extremely uncommon event.
** Please give your insurance card to Michelle when checking in if you have had ANY insurance changes. Any updates should occur prior to being called back.
**If you choose to brush before your appointment or go to the restroom, please do so prior to your appointment. If you are getting your teeth cleaned and you did not bring a brush from home, no problem! Just ask at the front for a brush and some paste.
Newsletter content from 11/11/09
Are you at risk for dental decay?
New research and technology have shown us that your risk for getting cavities may be defined by some much different factors than we had once believed. You have likely been told for years to brush and floss and avoid sugar if you wanted to avoid cavities. We now know that it has much more to do with the chemistry of your mouth and in many cases, brushing and flossing alone has little to do with lowering your risk for decay.
Cavities are caused by a certain family of bacteria that produce high levels of acids. It is these acids that breakdown, or demineralize, the enamel of the teeth and lead to tooth decay. These bacteria thrive in an acid pH environment. There are many factors that may contribute to having an acidic pH in the mouth, such as lack of saliva, medications that cause dry mouth, acid reflux, frequently consuming acidic beverages, etc. What we do know, is that if this acid environment exists and you have this bacterial infection, you are at much greater risk for dental decay whether you brush and floss diligently or not.
Teeth need calcium, phosphate and fluoride. Healthy saliva contains these minerals, and in conjunction with certain salivary proteins is able to deliver bio-available calcium and phosphate to the tooth surface during the demineralization/remineralization process. Calcium and phosphate are known to help:
Strengthen tooth enamel
Buffer plaque acid
MI Paste contains RECALDENT™ (CPP-ACP). This technology has a unique ability to deliver bio-available calcium and phosphate when they are needed most. MI Paste binds calcium and phosphate to tooth surfaces, plaque and surrounding soft tissue. The RECALDENT™ (CPP-ACP) technology releases the calcium and phosphate when saliva is acid challenged by the normal digestive process.
We now carry MI Paste and MI Paste Plus (w/fluoride) at our Office. Ask Dr. Dismuke or your Dental Hygienist if MI Paste is right for you. If you suffer from "white spots," frequent decay, have had extensive restorative work, or are just wanting to ensure that you have the healthiest teeth possible, then you WILL benefit from the regular use of MI Paste.
For a GREAT, INFORMATIVE VIDEO click on the link below or copy/paste the address into your webbrowser box.
click here ----------> www.facebook.com/video/video.php?v=132927564334
What is Xylitol?
Pure xylitol is a white crystalline substance that looks and tastes like sugar. Studies using xylitol as either a sugar substitute or a small dietary addition have demonstrated a dramatic reduction in new tooth decay.
Xylitol is right here, inside, already. Our bodies produce up to 15 grams of xylitol from other food sources using. Xylitol is not a strange or artificial substance, but a normal part of everyday metabolism.
Xylitol is widely distributed throughout nature in small amounts. Some of the best sources are fruits, berries, mushrooms lettuce, hardwoods, and corn cobs.
Xylitol can also be conveniently delivered to your teeth via chewing gum, tablets, or even candy. You can implement our xylitol program anywhere, anytime. It fits right in with the most frantic schedules and you don’t need to change your normal routine to make room for xylitol. Some health regimens require iron willpower, discipline, and commitment. But xylitol tastes so good that it becomes automatic.
Children love it! PETOWNERS - KEEP IT AWAY FROM YOUR DOGS! (The American Veterinary Medical Association (AVMA) has reported that Xylitol may be toxic for dogs.)
For more information on Xylitol, please visit our website (www.dismukedentistry.com) and go to the FAQ page, scroll to the bottom and click on the XYLITOL link.
GREAT GUMS TO TRY FOR XYLITOL: All STRIDE flavors, many TRIDENT and ORBIT gums have xylitol. Trident will say it on the front and Orbit will have it in the ingredients. Sam's Warehouse or anywhere you can buy in bulk, you get a better deal than pack-by-pack purchase in the store.
Trident Xtra Care Sugarless Gum contains RECALDENT AND XYLITOL!
HOLIDAY HOURS: Thanksgiving week we are working Monday 8:30am to 5pm and Tuesday 8am to 5pm. After Thanksgiving and prior to Christmas Week we are open normal hours Monday thru Thursday. During Christmas Holidays we are in the office on Mon, Tues, and Wed (12/21,22,23,28,29,&30), closed on Christmas Eve & Day, closed New Year's Eve & Day.
IF YOU HAVE NOT SIGNED UP AT WWW.SMILEDASH.COM yet, you don't know what you are missing! Be sure to register and if you have any problems, just give us a call.
Wishing you and yours a wonderful holiday season,
William F. Dismuke Jr, DDS, PC & Staff
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