Articles & Info
Preqnancy and Dental Health
Whatever exists in normal life also exists in pregnancy. It is just that with pregnancy, there isn’t anything happening that is routine. Just ask any mother. During pregnancy anything extreme is normal. What you eat, or feel like eating; how you feel physically; your emotions (that’s another story), hormonal and body changes including the obvious and not so obvious. What does all that mean for the expectant mother and her dental health?
Technology and Healthcare Costs
Question: Does technology increase or decrease health care costs?
That is a good question and the answer lies in how it is applied. Obviously, technological advancements have inherent costs. Research and development can be quite significant. For example, a revolutionary new development in dental filling materials is in the works. Very high tech and very promising. The evaluation process starts at a materials research company not directly related to dentistry. Next, it goes to dental manufacturers who will test it and formulate it into appropriate filling materials. The field testing by dentists will further refine the product. All this will take 5 or more years of work. What is this simple ‘invention’ worth? If, as suspected, it revolutionizes tooth colored fillings in the molar regions, it will significantly reduce dental costs in the future by minimizing wear and tear remakes. At the present time the most durable restorative materials are made of cast metal or processed porcelain. These are expensive. This new material will be significantly cheaper. Multiply that by the millions of fillings placed in the back of the mouth each year and the savings will be enormous.
Then there is research that is investigating the viability of primal stem cells in the pulp tissues of the tooth? This is a highly technical area with significant costs attached, but one can easily imagine the benefits if a new line of active, bio-diversified stem cells can be procured without all the other political, social, religious and bureaucratic issues attached. Score another one for technology.
What about high-end dental lasers and CT-Scan machines? The same process exists but the costs to purchase, let alone develop, such high-tech tools are much greater, anywhere from tens of thousands to well over one hundred thousand dollars. The question is what exactly is the patient benefit derived from these tools? Greater comfort, quicker treatment? Or do they also offer improved health? What will insurance companies do about coverage for such processes? Finally, what motivates a dentist to invest in such a technologically advanced device?
I believe the best way to answer the first question is to set up a risk-reward equation. If a patient needs treatment that has low risk (this ‘risk’ includes the health, comfort, emotional, time and financial costs) then the benefits received will have less value. On the other hand, if a procedure such as a multiple implant-supported prosthesis costing over $10,000.00 is planned, it becomes imperative that CT-Scans and CAD-CAM planning and design be used to minimize any human error. The cost of a mistake in this type of dentistry can be immense. Technology wins this round also.
Lasers have pluses and minuses and they are case specific. For instance, do lasers used for periodontal treatment truly improve the end result or are they equivalent to traditional tooth scaling done by the hygienist? It is known lasers hurt less, but if they don’t markedly improve perio health above hand scaling is their cost justified? It is certain they will cost more and insurance likely will not pay for it. Soft tissue lasers used to cut soft oral tissues are very nice alternatives to blade surgery when applicable. I often recommend soft tissue laser cutting procedures over a scalpel approach, especially when a child is the patient.
Not all insurance plans cover such advanced care. Their choices are primarily determined by the carriers’ business plans and their need to create quarterly profits. The main reason they are in the insurance business is to make money. They don’t make money when they pay out benefits, but, without a sensible benefit plan, they won’t get subscribers. They selectively create a balance of rewards and restrictions. They too look at the long term to evaluate how such technologies will affect their bottom lines later on. It is very complex and demands intense financial oversight.
Why do health practitioners invest in such expensive tools? To make a greater profit in their business by enticing patients to their locations with their state of the art systems. We like ‘state of the art’ systems. This applies to individual doctors as well as hospitals. The problem comes when too many nearby businesses carry the same tools, reducing the frequency of use of their investment. What may ensue is the desire to recoup the expenses by promoting the need for the service in marginally appropriate circumstances. This is often the case when one hospital picks up a new x-ray or scanner and the other hospitals try to keep pace to maintain patient load. Additional costs come from the subsequent advertising each must engage in to entice new customers. Advertising is expensive. But remember it is only advertising, not a legal affidavit of care. Many cases of improper advertising exist. Always seek out trusted sources to assist you in deciphering your options.
In the end, if money were not the issue, high tech medicine would be an automatic winner. We all want the best available care. However, we are known world-wide to have a very expensive health system relative to the benefits gained. The patient rarely gets to decide what technology gets used and when. It is up to the practitioners and organizations to make those choices, and unfortunately, it is not always the best one when it comes to the patients’ well-being and financial welfare. Let the patient beware.
How do patients protect themselves? Read up on whatever is planned for them. When appropriate, ask for second opinions and ask to talk to other patients who have received it. Seek out other approaches to compare against. If there is any defensive posturing by the practitioner, be wary. That's being a smart consumer.
Dental Insurance Matters
This time of year presents a critical moment of decision making when it comes to selecting dental insurance. Most plans provide an open enrollment opportunity in the months of November and December. As a practitioner I get to work within the networks of insurance plans and I very often find patients regretting the choices they make at this time. It is very important to make correct choices and take advantage of the opportunities to select the best plans. This column will address the complicated area of dental insurance by trying to simplify and guide your choices toward the plan that works best for you.
There are three primary types of dental insurance: DMO and DHMO plans, PPO plans and Discount plans. What are the benefits and shortfalls of each type?
In DMO or DHMO plans, the lure to the consumer is they are part of a group setting that enables them to procure a plan with very little out of pocket expenses for the dentistry they receive. The catch is consumers must stay with participating doctors, and there are few participating dentists in DHMO plans. The reason is because there is a negative cost-profit discrepancy between the cost of doing business and compensation for individual DHMO services. This limits the number of participating dentists and the availability of quality services available to the consumer. To adjust for this low fee rate, DHMO plans give participating dentists a small monthly capitation fee (typically $5-7) for every patient on his list, whether or not they seek treatment. Cost control is king for the dentist in DHMO plans. The obvious motivation for the dentist is to gather as many patients into the pool as possible and see as few patients in the pool as possible to maximize profits.
Monthly premium costs may or may not be lower than PPO plans. Review your needs and determine if such a plan works for you.
PPO plans are much more popular. Any major carrier, and there are more of them, will offer a wider variety of PPO plan options to a company (or individual) that wishes to provide dental insurance to its employees. Patients participate in PPO plant to get dental care at adjusted fees. Doctors participate to gain access to a larger number of patients through these corporate purchased plans. When a doctor participates in a carrier's plan system, he participates in all the plans within that system. PPO plans also attract more dentist participation because the compensation rates are higher than DHMO plans. However, the variety of plans can be nearly unlimited. This creates a very large logistical load for both doctors and patients to understand and that creates a knowledge gap for both. If it is vital for a patient to maximize insurance coverage and minimize out of pocket cost for a given treatment, they must carefully read and understand their limits and exclusions for their plan. It frequently occurs that patients get treatment rendered that is not covered due to some unique clause in the master contract. Countless experiences of such misunderstandings exist in dental care. Know your plan and predetermine treatment as much as possible.
PPO patients can go out of network but will pay the balance of the full dental fee less out-of-network insurance payments if they do.
Discount Dental plans are a newer product provided by the same carriers as PPO and DHMO plans. Discount plans have fewer restrictions for the consumer. To the dentist, they offer decent, reduced compensation rates, similar to PPO rates. Patients pay at the time of service. The insurance carrier does NOT make any payment toward treatment. The advantage to the dentist is in the immediacy of the transaction with the patient. For the patient there are no questions about approval or denial of coverage, just a reduced fee schedule with no annual maximums. The patient pays the entire, 'adjusted' fee to the dentist. While that puts more out of pocket cost to the consumer there are advantages: transparency and simplicity for one, and no annual limits. Of all the plan types this works best if you know you are going to need a lot of dental care in a short time period. You can get all the work done at discounted rates, which can be very valuable. Add flex spending options and your costs can be further reduced. Each person must investigate their particular circumstances carefully.
The issue of dental insurance is immense. When choosing and using it, be on top of your game. In the end the patient is ultimately responsible for any uncovered expenses. Don't get unpleasantly surprised.