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)

 



Certain kinds of medications can have an adverse effect on your teeth.

Long ago, children exposed to tetracycline developed tooth problems, including discoloration, later in life. The medication fell out of use, however, and is not an issue today.

The best precaution is to ask your family physician if any medications he or she has prescribed can have a detrimental effect on your teeth or other oral structures.

A condition called dry mouth is commonly associated with certain medications, including antihistamines, diuretics, decongestants and pain killers. People with medical conditions, such as an eating disorder or diabetes, are often plagued by dry mouth. Other causes are related to aging (including rheumatoid arthritis), and compromised immune systems. Garlic and tobacco use are other known culprits.

Dry mouth occurs when saliva production drops. Saliva is one of your body's natural defenses against plaque because it acts to rinse your mouth of cavity-causing bacteria and other harmful materials.

Some of the less alarming results of dry mouth include bad breath. But dry mouth can lead to more serious problems, including burning tongue syndrome, a painful condition caused by lack of moisture on the tongue.

If dry mouth isn't readily apparent, you may experience other conditions that dry mouth can cause, including an overly sensitive tongue, chronic thirst or even difficulty in speaking.

Heart Disease

Poor dental hygiene can cause a host of problems outside your mouth—including your heart.

Medical research has uncovered a definitive link between heart disease and certain kinds of oral infections such as periodontal disease. Some have even suggested that gum disease may be as dangerous as or more dangerous than other factors such as tobacco use.

A condition called chronic periodontitis, or persistent gum disease, has been linked to cardiovascular problems by medical researchers.

In short, infections and harmful bacteria in your mouth can spread through the bloodstream to your liver, which produces harmful proteins that can lead to systemic cardiac problems. That’s why it’s critical to practice good oral hygiene to keep infections at bay—this includes a daily regimen of brushing, flossing and rinsing.

Antibiotic Prophylaxis

In some cases, patients with compromised immune systems or who fear an infection from a dental procedure may take antibiotics before visiting the dentist.

It is possible for bacteria from your mouth to enter your bloodstream during a dental procedure in which tissues are cut or bleeding occurs. A healthy immune system will normally fight such bacteria before they result in an infection.

However, certain cardiovascular conditions in patients with weakened hearts could be at risk for an infection or heart muscle inflammation (bacterial endocarditis) resulting from a dental procedure.

Patients with heart conditions (including weakened heart valves) are strongly advised to inform our office before undergoing any dental procedure. The proper antibiotic will prevent any unnecessary complications.