Wednesday, December 17, 2014

Dental Insurance Part 2

Took a little bit longer than I anticipated to get to writing this second portion of the bit on insurance.  To rehash, the previous post covered the types of insurance, in-network versus out-of-network coverage and some other basic information.

Now I would like to touch a little on benefits.

Having a particular insurance doesn't mean it covers things the same as another plan on the coverage.  Your specific plan is usually dictated by your employer (if that is who the coverage is through).  Delta Dental, for example, has thousands of plans that are all different.  Sometimes the plans are different for people in the same household.  Many of the plans with Delta Dental are what is referred to as incentive plans.  With these plans, everyone will start out at a base percentage for most procedures and it goes up each year you use it until most procedures are covered at 100%.   If you neglect to use it one year, the coverage usually drops back to the starting level.  We love these plans as they work at keeping you in good shape by keeping you on track with appointments.  Patients sometimes hate having the out of pocket expenses the first 3-4 years of cleanings if they are used to having preventative covered at 100%, but come to love the plans when they don't have an cost to replace that old crown that popped off.

Another time that insurances have different benefits for those in the same family is for things that are age related.  Fluoride is one of the most important supplements we can have to let our teeth develop as strongly as possible.  Everyone who has enamel can benefit with a fluoride treatment.  Some insurances recognize that, but some will say that they will only pay for the benefit up to a certain age. Children are at higher risk of tooth decay because they typically have the worst diets and worst hygiene, but this isn't the case.  Its why insurances in general will pay more for fluoride and more frequent radiographs with children than with adults.

Another thing insurances do that can be tricky is downgrading procedures.  They will say that they will pay a certain percentage of a tooth colored filling or crown, but when the time comes to pay, they will sometimes change it up and downgrade the treatment to the lowest cost alternative treatment.  You may want a tooth colored filling on the front side of the tooth and they insurance company may say you can, but they will only pay the percentage for the silver filling.  This doesn't mean that you can't get the treatment that you want, but it means you will be responsible for the difference between the two types of treatment in addition to your copay.

Worst of all, your insurance company will sometimes request preauthorization for certain procedures and make you wait weeks until they let you know if they will or won't pay for it.  Sometimes they authorize treatment but the fine print says they don't guarantee benefits.

Insurance companies also like to just reject treatment all together, change their PO Box address so it takes longer for them to receive your claim, or request information that they don't typically need in order to keep from paying the claims in a timely manner.  Like any business they are out to make money (Delta Dental is technically a not for profit corporation, but that is more tax status and they make a pretty penny off of all of those insured and have the multimillion dollar CEO just like the rest of them).  If they can keep your money that your premiums paid for a little longer, they make more money off of it.

In short, if you feel like the insurance company is trying to pull the wool over your eyes, they probably are.  They have a number of tricks to make money.  When you are in our office, I like to say there are three people in the room.  Your dentist, you and your insurance.  Two of them care about your dental health.

We are typically very good at providing estimates on treatment and limiting surprises by doing benefit checks before your appointment and trying to preauthorize treatment whenever possible, but sometimes there is no predicting what they will do.  Some insurances won't pay for replacing tooth structure lost because of acid reflux, but will pay if you lost tooth structure by opening beer bottles with your teeth like crazy Uncle Cleatus.  It's maddening.  We are hear to help you understand.

Many insurance companies have great plans and many have really poor plans too.  If you are unhappy with the coverage of your plan, you employer can sometimes get a better one with the same company by just threatening to leave.

Hope this helps understand the mess the insurance industry is in.  It's getting worse with the ACA and government involvement.  Many of the plans through the exchange won't even tell us the benefits until after treatment is done and claims submitted.  It is unreal!

Everything should be as clear as mud now.

Wednesday, November 26, 2014

Dental Insurance Part 1

The end of the year always has two groups of people in a dental office.  Those with remaining benefits and those waiting until they get new benefits.  
I thought it might be fitting to do a few pieces about dental insurance as best I can and post it here on the blog as a resource for those wanting it.
In the mid-1950s dental insurance came to be.  It was actually a pretty straightforward way to try and increase availability to dental care.  The move was actually led by dental organizations in California, Oregon and Washington and over time became what we call Delta Dental.  Delta Dental has changed over the years and isn't exactly the same organization, but is still the largest insurance carrier for dental benefits.  Especially here in California.

Back when Delta started most plans had an annual maximum of about $1000-$1500 per person per year.  This is when the average cost of a dental crown was about $100.

Here in 2014 there are a seemingly infinite number of plans that are out there and an equally large number of insurance companies.  Funny thing is, most have an annual maximum of about $1000-$1500 per person per year.  (Anyone thing the premiums for these plans have stayed the same?).  For those keeping track at home, the average cost of a crown today is a little over a $1000.  Are we getting the same bang for our buck?

To complicate things further, there are really 3 main types of dental insurance.  

Indemnity Plans are what most people think they have, but very few actually do.  These plans do not have networks.  They pay for services that are performed at set percentages (varies by plan) at a dentist of your choosing.  In most cases, dentists will bill the insurance for you and accept assignment so you pay only your copay and the insurance company will pay the dentist the rest of the fee.

The most common type of plan is the PPO (preferred provider plan).  This plan is similar to the indemnity plan as you do have some choice in who you can have as your dentist.  Some plans are what is called an EPO (exclusive provider option) that companies market as a PPO, but they may not provide any benefits to your chosen dentist.  The PPO plan allows you to choose who you can see, however, they have some dental networks.  In network dentists have agreed to accept lower fees for those who have the plan in exchange for those companies to try and encourage them to go to their office.  Some insurance companies networks offer fees to dentists that are pretty close to what is termed UCR (usual, customary and reasonable), other insurances offer fees that are significantly lower.  The better your insurance pays, the more dentists who will have signed up for it.  Our office plan is to work with insurances who provide fee schedules that we can provide quality dentistry for.  We personally have chosen to not have different materials, different labs and different quality of work for different insurances.  It is unethical and something we don't want to be part of.  Most PPO plans will still allow you to see your preferred dentist and your benefits are the same, but the the dentists regular fees.  Some plans make it difficult to see an out of network dentist.  We always  are willing to do a benefits check for anyone so you know what we know about your plan.  

The last type is a HMO plan.  We do not participate in any of these plans and there are fewer dentists who do than the other types.  Most likely, you will be assigned a provider.  In our area, the dental chains are the primary providers for these plans (Bright Now!, Brentwood Smiles, Western Dental) although there are a few other offices that will be part of these plans.  Here a dentist will get paid a monthly fee for being your dentist and in return you get your dental care from that office.  Typically, HMO plans will cover very limited services.  The patient will have the choice to get these services and is typically pressured to upgrade to different types of treatment that is not covered by the insurance and has a higher fee.  Sometimes, the treatment that is covered is not something that any dentist would recommend, other times the fees for the covered service at HMOs are so low that the dentist will lose money on the deal.  Our recommendation is that is you have an HMO, try and get a different type of plan.  You deserve choice in who you see.  The most common HMO we see is DeltaCare USA which is administered by Delta Dental, but still assigns you a dentist.  There are probably some good offices that accept HMOs, but there are a lot of bad ones too that have a corporate bottom line.

In general, there are 3 entities that decide the oral health care for patients with insurance.  You are one.  Your dentist is another.  The third is the insurance company who is trying to not have you get any work done.  We will give a little more information on how your insurance benefits are given in another post.  

Interesting fact, while dental insurance was started to increase oral health care access, it hasn't done much more than complicate things.  In the 1960's it was estimated that 50% of people had visited a dentist in the previous year.  Currently, it is estimated that only 47% have visited a dentist in the previous year.  I don't think its working.  I'm guessing a lot of patients have been scared off from dentistry.  Maybe the grew up with an HMO plan.

Saturday, August 9, 2014

Dental Implants

Most adults are programmed to have 32 adult teeth.  Twenty of these replace our twenty primary teeth and twelve fill in the spaces behind those as our jaws grow as we mature.

The most common number of teeth I come across for adults is 28.  Most have had their wisdom (3rd molars) removed because we didn't have room for them, they became infected or we were told to avoid problems and get them taken out early for prevention.  Some have the room for the wisdom teeth and some don't.  Either way that is fine.  Some of us have even less teeth than that.

There are a few issues with when we lose teeth prematurely.

  • Bone loss: The teeth are place-holders in the jaw. When one falls out and is not replaced, the bone that once surrounded it begins to deteriorate and wear down.  Your bone will DEFORM.  Bone needs to be needed and if its not holding the place of a tooth or implant it will just go away
  • Bite changes: The loss of one or more teeth can cause the redistribution of bite pressure onto other teeth. Teeth are social creatures, they like to be touching other teeth.  If you have a space, teeth will tilt into that space trying to find a friend or grown down/up until they are hitting either your gums or another tooth.
  • Speech: A missing tooth can negatively affect the way you speak, depending on its location. It's not fun learning to talk again when you have dentures.  Losing your "voice" is losing a big part of your identity.
  • Gum disease: Shifting teeth can make it easier for plaque to accumulate in hard-to-reach places. This can increase the risk of gum disease, which can lead to additional tooth loss.
  • Aesthetics: A missing tooth leaves a visible gap between the teeth and can be a source of embarrassment and insecurity.  Stayplates, flippers, and partials are poor replacements for teeth aesthetically and functionally.  A replacement tooth you end up keeping in your pocket when you eat isn't what anyone wants.
Bone loss following extraction of the teeth.  

Guess what, we have pretty good thing in dentistry now that can help fill in these missing spaces.  It is integrated in bone and feels like a regular tooth.  It will keep you sounding the same, help keep teeth in place (actually, being fused to the bone, it will move not at all where your other teeth still will.  In terms of staying put, its BETTER than your natural tooth), you can floss it unlike a bridge so it keeps your gums happy, it doesn't require a crown on adjacent teeth compromising them, it holds up bone. 


Implants are in the most simple terms titanium posts that are placed in the spot left vacated by your missing tooth.  Sometimes we can place them in the same day you get the old one taken out.  Sometimes we need to add a little bone and let it heal.  That titanium post needs a few months to fuse to the bone before we can ideally place a tooth to it.  To do that, something called an abutment screws into the post and sticks into the mouth so we can add the third part, a crown that is cemented in place or screwed in place and can allow you to function as you were before.

Implant costs are usually slightly more than a bridge with a few major benefits added.  From a dental perspective, we don't have to unnecessarily shave down neighboring teeth to make a bridge.  Secondly, they feel and can be cleaned just like your natural tooth.  Lastly, they tend to last a lot longer and they don't get cavities.  They are by far the closest thing we have to a permanent solution in dentistry.  In the long run, they are the most cost efficient option.

Let us know if you want to have a consultation for implants at your next appointment.  Sometimes we place the implant here in the office without any extra workup necessary.  Sometimes we will send you out for a 3D scan if we are fitting the implant in a tight spot and need exact measurements.  Sometimes we will refer to to a specialist (usually oral surgeon or periodontist) if the case is more complex as we would any other specialty.  As always, we are happy to do a benefits check to see if your insurance benefits can help.  Thankfully, more insurances are offering coverage where they weren't just a few years ago.  Those that know anything about insurance companies know that they only want to cover the bare minimum and be cost efficient.  Implants are the present and future.

Wednesday, May 14, 2014

Don't Trip on Acid!

Dental decay is a pretty simple process.  It is usually explained as we eat sugar, bacteria in our mouths consume that sugar and metabolize it into an acid that gets dumped in our mouth.  That's right, bacteria poop acid on our teeth.

Acid erodes tooth structure.  It is that simple.

Unfortunately, it is very easy to forget we get a lot more sugar from things that we don't necessarily think of as "sweets."  Foods can be very broadly be broken down into carbohydrates (sugars), fats and protein.  I'm not pushing an Atkins Diet on anyone, but protein and fat do not cause cavities.  Pretty much everything else can.  Sticky carbohydrates are some of the worst offenders because they tend to stay in our mouth the longest.  Mix a glass of water and sugar and drink it.  It goes down the hatch pretty quickly.  A nice PB&J sandwich, Tootsie Roll or chocolate bar may taste great, but it tends to stick to the teeth.  Once it stays in the mouth, the millions upon millions of bacteria that co-habitate with us begin their feast.  And like us, they poop...but they poop acid and they poop it right in our mouth.

Avoiding sugar is getting easier and easier.  I can't even keep up with the sugar substitutes that are out there.  Guess what?  The vehicle we usually get them in is very acidic.  We just cut out the middle man of the bacteria and bathe the teeth directly in an acid bath.

Here is a chart of different foods and drinks and the relative acidity of them.


Diet sodas, diet energy drinks, many fruits are very acidic.

I'm not telling you to avoid eating whatever you want.  I usually drink a ton of water, but right next to the bottle on my desk is a bag of M&M's.  We have means of remineralizing our teeth after an acid attack if we can minimize the attach and raise the pH of our mouths to a more neutral level.  After eating or drinking something acidic, wash it down with water, as much as you can.  Try and not brush immediately after eating any of the problem foods we listed.  Rinse first and wait a bit.  We can actually even do damage to our teeth by brushing them in a acid softened state.

Most of the cavities we see are still the traditional "pit of the tooth" cavities were sugary foods get stuck.  As more and more acidic drinks come out we are seeing more and more "smooth surface" cavities in teenagers and young adults than we ever have before.

We are hear to prevent damage first and we would rather do that than help fix problems as they arise.

Tuesday, February 18, 2014

Dental Assurance Plan

The beginning of the year is always busy with insurance patients eager to start using their insurance again after it being maxed out the previous year.
Some are distraught to find out that the condition of their oral health has deteriorated from their past visit as decay and periodontal disease aren't up to waiting for your benefits.  They keep up the destruction.
Some have been waiting for their new benefits so they can treat the broken down teeth in the front at the same time for ideal aesthetics.  They may find out that there specific plan doesn't pay for replacing tooth structure lost from acidic erosion from GERD (while opening a beer bottle with their teeth is apparently an acceptable loss of tooth structure, thank you Delta Dental).
Dental insurance is not really insurance as we tend to think of it.  Sure there are deductibles but the caps and limitations we see on dental plans is much worse than our typical health benefits.  I'm sure we would be outraged if we were turned away from our health care provider because we already had a sore throat in the last two years.  Dental insurance is much more like a dental coupon book that has specific limitations in the fine print.  While having dental insurance can be great is fantastic for those with limited treatment needs and in the maintenance phase of treatment.  There are some insurances with high annual maximums, no limitations, low deductibles that really can benefit your oral health.  It is a messy subject.
Many of us do not have insurance and that caused me to figure out what alternatives there are.  Those patients when motivated are typically great to work with as we don't have the worry of what insurance covers.  We know our options, weigh costs, risks and benefits on the spot and determine how to proceed without the worry of what insurance companies will pay for.  Quite often, costs do come into play and people put off treatment until they have some sort of insurance.
Freitas Family Dentistry is proud to offer our Dental Assurance Plan as another option.  For some this will be a no brainer, some may not benefit as much.  We think most will.  How does this work?
For the first adult member of the family the cost for an annual membership is $250.  For each additional adult (spouse or child up to age 26) the annual membership cost is $200.  Each child membership (17 and younger) is $175 for the year.
The annual membership includes 2 healthy cleanings per year, all needed x-rays and exams at those visits and a 25% discount on all treatment (elective or otherwise) that can be completed in our office.  The best part is that we have no annual maximums on treatments, no deductibles, no waiting period, no claims to file and no rejections from insurance companies.  Of course sometimes it is best to have certain treatment completed by specialists outside the office and there will not be any benefits of our Dental Assurance Plan out of office.  The cost of the annual membership is actually less than the value of the two cleanings, x-rays and exams included, so for those without insurance its a no-brainer.
We think this is a win-win for you and for us.  You save money on preventative and restorative treatment and we get your commitment to letting us take care of your health for the year without having the headache of filing insurance claims, determining benefits and the other headaches we deal with when it comes to insurance companies.
If you have insurance we are ready to do a complimentary benefits check for you and help you maximize your insurance as well.  We are preferred (in-network) providers for Delta Dental Premier, Delta Dental PPO, Metlife and Cigna and work with almost all PPO plans to maximize your benefits (many offer you no real benefits to see an in network provider and some do, we will check).  Give us a call at (925) 634-1230 or check out our website at www.freitasdentistry.com for more information.

Tuesday, February 4, 2014

Benefits of Mouthwash

Some of us use mouthwash on a daily basis.  Others never use it at all.  There are a myriad of reasons to use a mouthwash and just as many types of mouthwashes to use.

A mouthwash, or mouth rinse, is a great addition to your oral hygiene regimen but definitely not a replacement for brushing or flossing.

Most of us use mouthwash for its cosmetic benefits of improved breath and improving the taste of our mouths.  This is the most common use of mouthwash but also the reason that benefits us the least.  However, it does act as a gateway into the more therapeutic uses.

Many mouthwashes are anti-septic in that they kill the germs that cause plaque, decay and gum disease.  Traditionally, these main agent in accomplishing this has been alcohol.  Most of us are very familiar with the sting of some of these formulations letting us know that its working.  Fortunately, there are a number of new alcohol free versions that don't hurt.  Trust me, they still work.

Another class of mouthwash is for anti-cavity properties.  The active ingredient in this case with fluoride.  We often encourage kids, whether cavity prone or not, to rinse with ACT mouthwash to help strengthen enamel and help keep the cavities away.  The key here is making sure your child is old enough to not swallow.  Fluoride is great topically in our mouth but we don't need to ingest the amounts in the mouthwash. Many adult mouthrisnes now contain fluoride as well.  These mouthwashes are most effective if you don't eat, drink, rinse or smoke for 30 minutes after to keep the fluoride from becoming diluted.  Please don't smoke regardless.

On the other end of the spectrum, once we get older we tend to get more dry mouth.  There are mouthwashes such as Biotene specifically formulated to keep your mouth lubricated.  Without great saliva flow, we lose our natural defenses to cleanse our teeth and bacteria and decay can run rampant.

What do I use?  Listerine Zero is a alcohol free mouth rinse that I love the flavor of and keeps my mouth feeling clean.  Crest Pro Health is another great rinse that many love.  Like Listerine Zero it is alcohol free and does contain a fluoride containing version.  I personally don't feel as fresh after using it as the Listerine version, but many prefer the flavor.  Even though I don't personally care for it, I have no hesitation recommending it.

Most important to remember is that these rinses are great additions to brushing and flossing and not replacements.  With Valentines Day right around the corner, the freshness of breath doesn't hurt.