Covid and Dental Insurance

Sandy Springs Dentist near meThe Dental Care System is MORE Broken since COVID. The insurer-controlled dental care system has been broken for years! And now, a model that did not work prior to COVID-19 is only getting worse. Patient distancing has forced lower patient volumes and decreased production, while the cost of PPE and infection control further misaligns practice costs and PPO reimbursement. Can your dentist be profitable on our existing PPO fee schedules and terms with a 25-35% decline in production and a 5-10% increase in costs? What happens when PPOs lower your dentist’s fees next year and subsequent years? 

We know you would like to see the cost of delivery come down, but it’s not.  In the new Covid environment it costs more to deliver your dentistry and the insurance companies are fighting dentists tooth and nail to deny these increases in delivery.

We need your help in pushing back on your insurer.  You need to contact your insurance commissioner and let them know your needs are the same, but your coverage is under attack and being reduced by the powerful insurance controlled dental care system.

Novy Scheinfeld, DDS, PC

ZoAnna Bock, MS, DMD

Hanna Orland, DMD

Howard Abrahams, DDS

290 Carpenter Drive, 200A

Sandy Springs, GA 30328

404-256-3620

And

3781 Chamblee Dunwoody Road,

Chamblee, GA 30341

770-455-6076

info@rightsmilecenter.com

www.rightsmilecenter.com

FAQ of the Right Smile Center

FREQUENTLY ASKED QUESTIONS

Drs. Zoey, Novy and HannaWhat type of insurance does the practice take?
We will be happy to work with most dental insurance programs and process your forms at no charge. We will accept assignment of benefits for the portion covered by insurance and will help you make financial arrangements for your personal balance.

We are an out of network provider, but we do have an in-network provider on staff. Our business office staff will assist you in determining what portion of your treatment is covered by insurance. We will strive to help you obtain your maximum benefits by prompt and efficient processing of your claims. When questions arise regarding your insurance, please feel free to ask. Please bring your insurance card or papers on the first visit. We will help you in every way possible. Please understand that you are ultimately responsible for payment of all services. Should your insurance not cover what is predicted, you will be responsible to pay any uncovered portion.

Does the practice offer financing? 
We are sensitive to the financial concerns of our patients. Most dental insurance programs simply don’t cover some or all of the treatments you and your family may require. Drs. Scheinfelds, Orland & Tourial have developed financing services that help meet these expenses. Speak to our patient services coordinator to find out how we can help develop solutions to your financial concerns so that you may receive the treatment that you need.

What are my payment options?
We accept most major credit cards (MasterCard, Visa, American Express & Discover). For your convenience, we will also assist you with billing your insurance for your treatment plan at no additional cost to you.

If you have more financial questions
Our Patient and Insurance Coordinator will be happy to answer any of your financial questions. She can be reached by calling our Sandy Springs, GA dentist’s office at 404-256-3620 or our Chamblee offece at 770-455-6076 . If you would like to contact her by email at info@rightsmilecenter.com.

Novy Scheinfeld, DDS, PC

ZoAnna Bock, MS, DMD

Hanna Orland, DMD

Howard Abrahams, DDS

290 Carpenter Drive, 200A

Atlanta (Sandy Springs), GA 30328

404-256-3620

and

3781 Chamblee Dunwoody Road

Chamblee, GA 30341

770-455-6076

www.rightsmilecenter.com

info@rightsmilecenter.com

Don’t Allow Insurance to Dictate Care

Sandy Springs Dentist near me

Your dental insurance company has never met you. So why do you value their opinion?

As the provider on the other side of the triangle, we understand how “dental insurance” companies really behave.  As a caring and compassionate health care professional, I want to use my education and experience to help you achieve the best level of oral and systemic health. Unfortunately, dental insurance companies are not set up to accomplish the same goal.

More often than we would like, after my front office compiles all of the supporting data and submits the claim to your insurance company, we receive back correspondence stating that they are denying the claim.

First, they stated that they did not receive enough supporting information, which is delay of payment #1.

So you know, we sent:

  1. X-rays
  2. Photographs
  3. Periodontal charting
  4. And, treatment notes

They respond, “No, we didn’t receive those. Please resend again.”

So we do. All the while we are designating one of our employees who now has to be paid to manage all of these communications and the shuffling of information. After more waiting, we get another rejection, which is delay of payment #2.

Then the insurance company states, “Our claims advisor does not feel that there is enough supporting information to support your claim. Therefore, we are denying the claim”.

My front office team shares with you that your insurance company, despite all of our supportive documentation, is denying your claim. We recommend that you call your insurance company for further clarification as we are getting nowhere. At this point, more than 3 to 4 months have passed since the treatment and the patient is feeling well and her symptoms have resolved.

Over the next couple of months, the patient made calls, we made calls and we both get the runaround about why the insurance company is not paying.

The strategy is if they can’t outright deny the claim, then at least delay the inevitable-payment.

After 5 or so months of the insurance company holding up the claim, we ask the insurance claims supervisor to put us in direct contact with the lead supervisor who is in charge of your claim. We set up an appointment for a conversation.

And then “miraculously” on the morning of the day where I was to talk with this “dental claims expert”, our Patient Advocate and Insurance Coordinator receives a call from the insurance company.

“It appears that the claim that you submitted has been “re-reviewed” and is now in process for payment. Would Dr. Scheinfeld or Orland still like to speak to our dental claims supervisor?”

So a company who has never met you is allowed to be in a position where they can determine whether payment is rendered for services. Yet they have never performed an exam on the patient.

They were able to hold up the claim for almost 5 or 6 months. This means greater profitability for the insurance company. Despite how ridiculous this scenario sounds, we constantly hear from patients who ask “Will my insurance cover this?”

What does your dental insurance know or care about your health? We will tell you what they know – how to increase their profits by not paying on your just claims in a timely manner. How does this make sense and do you realize how much money in staff time is devoted to your health care delivery?  And none of these costs benefit you in any way.

Novy Scheinfeld, DDS, PC

ZoAnna Scheinfeld, MS, DMD

Hanna Orland, DMD

290 Carpenter Drive, 200A

Sandy Springs, GA 30328

404-256-3620

And

3781 Chamblee Dunwoody Road

Chamblee, GA 30341

770-455-6076

info@rightsmilecenter.com

www.rightsmilecenter.com

Screwed By Your Insurance Company

Consumer being screwed

 HR 1418, the Competitive Health Insurance Reform Act, if enacted, will amend a section of the McCarran-Ferguson Act of 1945, which exempted the insurance industry from provision of the Sherman Act and Clayton Act.  The only other industry exempt from antitrust laws is Major League Baseball. 

It is preposterous that this anti-free-market exemption is still on the books, and the insurance industry abuses it to the detriment of you, the patient.  This exemption gives insurance companies the power to collude to drive up prices, limit competition, conspire to underpay doctors and hospitals, and price gouge consumers.

Not only will HR 1418 protect you, it will ensure the health insurance industry is subject to the same rules as virtually every other industry.  Patients, doctors, and hospitals all benefit when health insurers compete to provide a variety of quality coverage options. The healthcare market should be patient-centric and should provide a variety of affordable and quality options, all fostered by competition.

There is no reason in law, policy, or logic for the insurance industry to have special exemptions that are different from all other businesses in the US that has allowed the insurance industry to have ruined your healthcare for decades. The government should not be picking winners or losers, and the insurance industry should also have to comply with federal anti-trust laws. It is unthinkable that the health insurance industry has been permitted to avoid accountability for so long under the laws and standards that govern other aspects of American business.

Without repeal, dentists, patients, and the public won’t know the extent to which they have been affected by the McCarran-Ferguson Act’s negative impact on competition within the health insurance industry. Under the bill, consumers may finally receive the relief they need from being under the thumbs of the insurance industry.  CALL YOUR REPRESENTATIVES IN CONGRESS AND DEMAND THEIR SUPPORT OF THIS IMPORTANT LEGISLATION.

Novy Scheinfeld, DDS, PC

ZoAnna Scheinfeld, MS, DMD

Hanna Orland, DMD

290 Carpenter Drive, 200A

Sandy Springs, GA 30328

404-256-3620

and

3781 Chamblee Dunwoody Road

Chamblee, GA 30341

770-455-6076

info@rightsmilecenter.com

www.rightsmilecenter.com

Brookhaven Dentist: How Much Do Dental X-rays Cost?

A single dental x-ray would cost between $28-38. Four check-up or bitewing x-rays may cost between $60-80, and a full mouth series (18 x-rays) or panoramic x-ray would cost between $100-200. If it’s a new practice or mature one that is trying to build or rebuild its patient base, often the x-rays will bundled with an examination that ends up costing the patient virtually nothing.  Most dental insurance covers x-rays at 100%. It is usually considered a diagnostic or preventive service.

If you are a new patient, the dentist should take x-rays to determine the present status of your oral health and to help identify changes that may occur later.  They give your dentist a baseline of your present condition.  A new set of x-rays  helps us detect any new cavities, determine the status of your gum health or evaluate the growth and development of your teeth. If your previous dentist has any radiographs of you, we would ask you for copies of them.Brookhaven Dentist Near Me x-rays

We take four bitewings (which show us in between the back teeth to check for cavities).

Sometimes we take a full series of images (18 images or so…which show us cavities plus also shows us bone levels and nerve health).

A panoramic image is a single image of the entire upper and lower arch. This requires a different machine and can cost $125-175 or more. It shows the entire mouth on one image.

Many diseases of the oral cavity (which includes the teeth and surrounding tissues and bone) cannot be seen when the dentist visually examines your mouth.

Dental x-rays are used to diagnose or detect tooth decay, impacted teeth, jaw problems, abscessed (infected) teeth, or current filling placement.  An x-ray exam can help your dentist see the small areas of decay between the teeth and fillings; bone damage from a tooth infection or cyst; bone loss due to periodontal (gum) disease; developmental defects; some types of tumors; the effects of trauma; and the position on unerupted teeth in children and adults.  Dental x-rays can also reveal bone loss from periodontal (gum) disease, locate tarter build-up, find foreign bodies within the gum or bone, and see if there is enough bone for the placement of dental implants.

Finding and treating dental problems at an early stage can save time, money and unneeded discomfort and help prevent more serious health problems.  A good dentist will tailor a treatment plan to your finances, altering the ideal treatment as much as possible to help you be able to afford it.  If we can be of help, please do hesitate to call, email or make an appointment to be seen.

Right Smile Center

Novy Scheinfeld, DDS, PC

ZoAnna Scheinfeld, MS, DMD

Hanna Orland, DMD

Howard Abrahams, DDS

3781 Chamblee Dunwoody Road

Chamblee, GA 30341

770-455-6076

and

290 Carpenter Drive, 200A

Sandy Springs, GA 30328

404-256-3620

www.rightsmilecenter.com

info@rightsmilecenter.com

Your Teeth – Health Care’s Stepchild

Here is the biggest lie propagated about healthcare and insurance companies.

“Edentulism[1] is not a risk factor for any other diseases, so it is not a liability to the overall health of a patient.”

Doctor treating patient
Oral health care treatment

This lie that has been propagated for decades.  Bad teeth and long-term low-level infections can damage your lungs and heart, lead to increased and/or chronic lung infections and even lead to sepsis; death in extreme cases. In a cross-sectional study, Abed Al-Hadi Hamasha and others found significant differences between edentulous and dentate individuals with respect to rates of atherosclerotic vascular disease, heart failure, ischemic heart disease and joint disease.[2]

Although there are no data to support the contention that the compromised nutrition of edentulous people leads to adverse health conditions, it is known that nutrient deficiencies are associated with a variety of diseases. Therefore, it is possible that edentulous patients with poor nutrition may be at greater risk for a variety of diseases.[3]  As a consequence of a lack of certain nutrition due to altered eating habits, various health problems can occur, from the mild to the extreme. Lack of certain vitamins (A, E and C) and low levels of riboflavin and thiamin can produce a variety of conditions, ranging from constipation, weight loss, arthritis and rheumatism. There are more serious conditions such as heart disease and Parkinson’s disease and even to the extreme, certain types of Cancer.

The absence of teeth can damage your jaw bone’s structure.  In addition, the tongue, which consists of a very dynamic group of muscles, tends to fill the space it is allowed, and in the absence of teeth, will broaden out.  And the most ludicrous thing today that exemplifies the attitude I quoted, above, is that Medicare won’t pay for any dental work, or dentures – yet it will pay for a male erection (Viagra.)  Go figure.

If we can help you, please contact us.

Novy Scheinfeld, DDS, PC

290 Carpenter Drive, 200A

Atlanta, GA 30328

404-256-3620

info@rightsmilecenter.com

www.rightsmilecenter.com

[1] Edentulism is the condition of being toothless to at least some degree.

[2] Hutton, Feine, Morais, 2002

[3] http://cda-adc.ca/jadc/vol-68/issue-3/182.pdf

Dentist Atlanta: How Much Do Dental Bridges Cost?

Animated Dental Bridge
Animated Dental Bridge

The cost of dental bridges varies depending on the type of bridge and complexity of the bridge required[1], the expertise of your dentist and the area of town in which the procedure is performed. Typically a dental bridge cost ranges from $1200-1450 per tooth. Dental insurance will typically pay a percentage of the fee, depending on the individual dental plan.

It is important to keep your remaining teeth healthy and strong as the success of the bridge (depending on the type selected) depends on the solid foundation offered by the surrounding teeth. Brushing twice a day and flossing daily helps prevent tooth decay and gum disease that can lead to tooth loss. Our dental hygienist can demonstrate how to properly brush and floss your teeth. Keeping a regular cleaning schedule will help diagnose problems at an early stage when treatment has a better prognosis.  With proper care a dental bridges can last 5 to 15 years and even longer. With good oral hygiene and regular checkups, it is not unusual for the life span of a fixed bridge to be over 10 years.

If you’re a new patient, there’s often an initial office visit ($65-$102) and X-rays ($85-$135).  One must not forget that there are additional costs that contribute to the overall price involved in dental bridges, aside from the material and type of bridge chosen which are beyond the patient’s control.  The cost above does not include the costs for any anchoring on either side of the bridge.  So a 3 unit bridge could cost around $3,500 to $5,000.  A large share of undervalued costs goes toward the treatment itself, lab and production costs for the bridge, aftercare and the like.

Dental care on a whole is often considered expensive.  However, depending upon the general wear and tear a bridge or implant is exposed to and how well you keep your teeth free of plaque, it could last indefinitely.  With somewhere between 10 years and indefinitely, the investment becomes rather modest, if not inexpensive.

In the alternative, if the cost escalates, you might want to consider a single dental implant with a cost of around $4500 to $6000.[2]  The benefit on an implant over your lifetime could be less expensive than a bridge and is the more natural state of the art replacement of a missing tooth.   If we can be of service or answer any of your questions please do not hesitate to give us a call.

Novy Scheinfeld, DDS, PC

290 Carpenter Drive, 200A

Atlanta (Sandy Springs), GA 30328

404-256-3620

www.rightsmilecenter.com

info@rightsmilecenter.com

 

Related articles

 


[1] Is should be noted that both location of the missing tooth, the number of teeth involved or missing or whether there are virgin teeth or repaired teeth in front or behind the missing teeth come into play in the decision making process.

[2] The recommended standard of care for a single tooth missing is a single unit implant.  However, there are limiting factors, including bone height and width that come into play in the decision making process.

Dentist Alpharetta: Dental Frequency

Dental Insurance issuesNo, I am not talking about radio waves. This little phrase refers to how often a given dental treatment is covered.  The “frequency limitation” on a certain dental treatment covered by your insurance policy is one extremely important provision.  This element of your policy confounds both the patient and the dentist.  The insurer states clearly the frequency limitations in the policy outline offered you, so even if that dental surface develops a very bad cavity and develops over several surfaces of one tooth, the insurance may not offer any coverage.

This is why it is important that you have a very good communication with your dentist’s front office, particularly the person in charge of filing insurance claims.  After getting a dental surface filled, your dentist should show you good dental health practices on how to take care of that filling, and how to avoid developing another cavity on that surface.  Because more often than not, the insurance will not cover it within 2 years of treatment.

The same goes for crowns.  Once you have had the crown seated and something happens down the road or the patient develops a dental cavity under the crown, the insurer will usually not cover it again.  One of the more frequent problems with dental crowns is when they are not properly seated, the patient develops a cavity at the margin of the crown.  Once again, the insurer will not cover the restoration.

But denied dental claims should not be a reason to panic. As long as you have good communication with you dentist, and she is a truly good professional you should not have problems.  So it’s extremely important to receive dental work from a highly skilled dental practice that can create long lasting solid dental crowns and can address any potential dental issues correctly before the crown is placed.

If we can be of service or answer your questions, please feel free to contact us.

Novy Scheinfeld, DDS, PC

290 Carpenter Drive, 200A

Atlanta (Sandy Springs), GA 30328

404-256-3620

info@rightsmilecenter.com

www.rightsmilecenter.com

Related articles

Dentist Alpharetta: Denied Dental Procedures Alert

Insurance-Page-ImageA denied dental procedure does not mean the procedure wasn’t necessary.  It just means your insurance carrier won’t cover it as a benefit of your plan.  Limitations in an employer’s group policy most likely result in these noncovered procedures.  This is a huge problem for your healthcare provider, because your care provider is trying to do what you need and not what is paid for by your insurance carrier.  To compound these denials, some policies are designed such that they do not allow the dentist charge you for certain procedures.  However, that does not mean your dentist can avoid the procedure because it may be absolutely necessary as a part of your treatment.  This scenario has left your dentist wondering whether or not you will pay for the services being rendered because your insurance carrier is denying a necessary procedure and lack of patient understanding.  And finally, this scenario has left your dentist perplexed as to how to overcome the perception by patients that they are not being honest with them.

The solution is patient ‘push back’ for the coverage you’re entitled to.  Patients need to question, if not challenge the benefits they have paid for but have been denied.  And patients need to recognize that the contractual relationship is between you and your insurance provider, not your dentist and your insurance provider.  Your dentist has absolutely not leverage with your insurance carrier.

Hopefully, this is a little helpful in understanding the difficulties in receiving your full insurance benefits.   If we can answer any of your concerns or questions, please feel free to contact us.

Novy Scheinfeld, DDS, PC

290 Carpenter Drive, 200A

Atlanta (Sandy Springs), GA 30328

404-256-3620

info@rightsmilecenter.com

www.rightsmilecenter.com

 

Thank you for all your referrals.  We truly appreciate them.

Information included is not dental or medical advice.  For your specific information

 be sure to consult your dentist.

Related articles

Dentist Sandy Springs: Dental Frequency

Radio_FrequencyNo, I am not talking about radio waves. This little phrase refers to how often a given dental treatment is covered.  The “frequency limitation” on a certain dental treatment covered by your insurance policy is one extremely important provision.  This element of your policy confounds both the patient and the dentist.  The insurer states clearly the frequency limitations in the policy outline offered you, so even if that dental surface develops a very bad cavity and develops over several surfaces of one tooth, the insurance may not offer any coverage.

This is why it is important that you have a very good communication with your dentist’s front office, particularly the person in charge of filing insurance claims.  After getting a dental surface filled, your dentist should show you good dental health practices on how to take care of that filling, and how to avoid developing another cavity on that surface.  Because more often than not, the insurance will not cover it within 2 years of coverage.

The same goes for crowns.  Once you have had the crown seated and something happens down the road or the patient develops a dental cavity under the crown, the insurer will usually not cover it again.  One of the more frequent problems with dental crowns is when they are not properly seated, the patient develops a cavity at the margin of the crown.  Once again, the insurer will not cover the restoration.

But denied dental claims should not be a reason to panic. As long as you have good communication with you dentist, and she is a truly good professional you should not have problems.  So it’s extremely important to receive dental work from a highly skilled dental practice that can create long lasting solid dental crowns and can address any potential dental issues correctly before the crown is placed.

If we can be of service or answer your questions, please feel free to contact us.

Novy Scheinfeld, DDS, PC

290 Carpenter Drive, 200A

Atlanta (Sandy Springs), GA 30328

404-256-3620

info@rightsmilecenter.com

www.rightsmilecenter.com