Online Dental Education Library

Our team of dental specialists and staff strive to improve the overall health of our patients by focusing on preventing, diagnosing and treating conditions associated with your teeth and gums. Please use our dental library to learn more about dental problems and treatments available. If you have questions or need to schedule an appointment, contact us.

 

INSURANCE

Usual and Customary. What Does It Mean?

 

Every once in a while a patient calls us after receiving a statement from their dental insurance company and asks: “Your fee for this is over what my dental insurance company calls ‘usual and customary,’ does that mean you are overcharging me?” 

That’s a good question, one we’re happy to answer. 

Each separate insurance company has its own “usual and customary” fees for all dental procedures for a certain geographical region. When our state dental association asks these companies for data to see how the numbers were arrived at and which dentists (if any) were surveyed, they are told that this is privileged company information and they do not reveal that. 

The fact is that different insurance companies have different “usual and customary” fees for the same area.  If the calculations were done correctly they should all have the same fees.  But they don’t! In fact the ranges are quite broad. 

Because the insurance companies establish artificially low fees in an effort to keep their profit margins as high as possible, animosity can be created between the dentist and the patient.  The insurance companies’ main goal is to collect as much in premiums as possible while paying out as little as possible and delaying payment for as long as possible. That is how they make their money.  Unlike us, they do not have the patients’ best interest at heart.

What is Dental Insurance?

Dental insurance is nothing more than a contract between the employer and the insurance company to partially pay for certain services.  It exists to help in covering the costs; it was never intended to cover all the costs. There are deductibles, some services get paid at 50 % or 85 % and some aren’t covered at all. 

The type of insurance coverage your employer is willing to buy is determined by how much the employer is willing to pay for.  The employer selects as many or as fewer benefits they want.  The higher the premium paid by your employee – the higher is your usual and customary fee.

How Are Our Fees Set?

Our fees are set by the actual cost of doing business in this particular office.  Costs vary from office to office depending on rent, the salaries of out employees, quality of materials used, lab costs and many other "cost of doing business" factors.

For example, we will not compromise on sterilization because it’s just too important for our patients.  Likewise we will not use inferior materials for our dental restorations just to “save money”.  The fact is you never save money this way because the cheaper materials don’t last as long and the patient ends up back in the dental chair in a few years complaining that their crown or filling failed. We hire only the best, well trained staff, who love their jobs and give 110% every day to our patients care and customer service.

                          (information taken from Dr. Alex Shvartsman)

 



For decades, fluoride has been held in high regard by the dental community as an important mineral that strengthens tooth enamel, which thereby helps to prevent decay of tooth structures.

Water fluoridation is endorsed by nearly every major health and safety-related organization in the world. Communities make it a common practice to "fluoridate" their drinking supplies in order for the general population to benefit from this inexpensive and effective preventative treatment. According to the American Dental Association, more than 144 million U.S. residents in more than 10,000 communities drink fluoridated water, most from public water supplies with sodium fluoride added artificially.


Bottled water, home water treatment systems, and fluoride exposure

Can the consistent use of bottled water result in individuals missing the benefits of optimally fluoridated water? Can home water treatment systems (e.g., water filters) affect optimally fluoridated water supplies? The answer is yes to both. Read how you can avoid some of the pitfalls that may be preventing you from getting the maximum value of fluoride, in this article from the American Dental Association.

ADA statement on FDA toothpaste warning labels

The American Dental Association`s Council on Scientific Affairs believes that one part of the warning now required on fluoride toothpastes by the Food and Drug Administration (FDA) could unnecessarily frighten parents and children, and that the label greatly overstates any demonstrated or potential danger posed by fluoride toothpastes. The label language, "If you accidentally swallow more than used for brushing, seek professional help or contact a poison control center immediately," is now required on all fluoride toothpastes. But the ADA, in a letter sent to the FDA last year, pointed out that a child could not absorb enough fluoride from toothpaste to cause a serious problem and that the excellent safety record on fluoride toothpaste argues against any unnecessary regulation.

Enamel fluorosis

According to the American Academy of Pediatric Dentistry, a child may face a condition called enamel fluorosis if he or she receives too much fluoride during the years of tooth development. Too much fluoride can result in defects in tooth enamel.

CDC web site provides information on community water fluoridation

People seeking information on whether their water system is fluoridated can now find out by visiting a new Web site at the Centers for Disease Control and Prevention (CDC). The new feature, "My Water`s Fluoride," allows consumers in participating states to check out basic information about their water system, including the number of people served by the system and the target fluoridation level. Optimal levels recommended by the U.S. Public Health Service and CDC for drinking water range from 0.7 parts per million (ppm) for warmer climates, to 1.2 ppm for cooler climates accounting for the tendency to drink more water in warmer climates. States that are currently participating include Arizona, Colorado, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Maine, Massachusetts, Michigan, Minnesota, Nebraska, New Hampshire, Nevada, North Dakota, Oklahoma, Pennsylvania and Wisconsin.