| Dental Insurance Realities - Part 5 |
Continuing our discussion from December:
DUAL COVERAGE
I am covered by my own policy and by my spouse's. What does that mean? Having more than one dental insurance does not mean that your dental treatment is 100% covered. Intuitively, two benefit plans should mean two benefit payments according to the rules for each benefit plan irrespective of the other. After all, each plan is receiving a full premium, right? In reality that's not how it works. With dual coverage, one insurance company becomes the 'primary' and the other becomes then 'secondary.' It's not clear how the primary/secondary designation is made. The benefit plan in the 'primary' position typically behaves like a normal dental benefit plan: a claim is submitted and the payment is received. However, the 'secondary' plan's behavior is much less predictable. They may pay well or not at all. Typically the secondary does not pay until after the primary has paid its portion and another claim is submitted to the secondary. In our experience, it's impossible to get a pre-determination from a secondary benefit plan.
BENEFITS SOMETIMES CHANGE
Insurance benefit plan details change from time to time. It is in the best interest of the plan to reserve the ability to make changes from time to time. Contract language to that effect is included in every benefit plan. It's also common for patients to not know that a change has occurred or exactly what aspects of the plan have changed. Sometimes the out-of-pocket cost to the patient can go up dramatically because of changes in plan language. Other times certain procedures are removed from the list of 'covered' services.
GETTING PLAN INFORMATION
We as a provider call requesting information on behalf of a patient. We do this a lot. We are given basic plan information. Sometimes what we are told is wrong. We're told one thing and then the patient is told something else. We generally feel that the policyholder will get more accurate information than the provider will. And we do see miscommunication result in claim denial and even delays in completing treatment.
Next issue we will conclude this series of articles. |
|
|
|
|
|
|
|
| I Got a Root Canal, What Can I Eat?
|
During a root canal, the infected or inflamed pulp is removed so that you can keep the tooth. Immediately after the root canal is finished a temporary filling is placed to hold the tooth until the appropriate restoration can be done. The tooth is weak at this stage. Root canals are highly effective at keeping a tooth for many many years despite damage or infection. But the tooth needs a permanent restoration to protect the tooth and finish the job.
After you get a root canal, you may be wondering whether or not you should continue with your normal diet. We tell people to "avoid anything hard or sticky" until the crown is done. Foods like raw nuts and raw carrots are too hard and may break the tooth. Sticky foods can pull the temp filling out. Once you have had a root canal, you need to eat soft foods that need little chewing such as eggs, applesauce, yogurt, and fish. You'll also want to avoid eating for the first few hours after the procedure so that your numbness can wear off. This way, you won't bite your tongue or cheek. You wouldn't feel it while numb but you will still have the discomfort of bite trauma for a few days afterward.
Talk to us about the root canal procedure, we're happy to answer any questions you've got! |
|
|
| Dental Bonding: A Fix for a Chipped Tooth |
| You have probably chipped a tooth at one time or another and are wondering if dental bonding can help. You may be wondering, should I get bonding, a veneer, or a crown? Yes, dental bonding is a less expensive alternative to a crown or veneer for restoring chipped teeth. In addition to trauma, chipping of a tooth can occur when there is constant wear in a particular area of the tooth that weakens the enamel to the point where it breaks off. In general, if the chip is small then bonding is desirable since it is more conservative to the tooth structure. If the chip is large or the tooth is previously restored in other areas then a veneer or crown could be the best option. The dental bonding procedure uses a tooth-like composite resin (about the consistency of modeling clay) to replace the missing enamel. It can sometimes be done painlessly without the need for a local anesthetic. No impression or lab procedure is required and there is not a second appointment to cement the restoration to the tooth as with veneers and crowns. We often hear from patients about a minor chip of a lower front tooth and frequently decide not to restore it. |
|
|
