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Navigating the World of Dental Insurance Terminology

January 9th, 2019

Unless you work for an insurance company, you probably do not spend a lot of your time studying all the terminology that dental insurance companies use to describe the treatments and services they cover. If it seems pretty confusing, here are some of the most commonly used dental insurance terms and what they mean.

A Basic Glossary

Annual Maximum–The maximum amount your policy will pay per year for care at Kaye Dentistry. It is often divided into costs per individual, and (if you are on a family plan) per family

Co-payment– An amount the patient pays at the time of service before receiving care, and before the insurance pays for any portion of the care

Covered Services– A list of all the treatments, services, and procedures the insurance policy will cover under your contract

Deductible– A dollar amount that you must pay out of pocket each year before the insurance company will pay for any treatments or procedures

Diagnostic/Preventive Services– A category of treatments or procedures that most insurance will cover before the deductible which may include services like preventive appointments with Drs. Kaye, Tushman, Goldstein, Jacobs, Wexler, Novison, and Salaverry, X-rays, and evaluations

In-Network and Out-of-Network– A list of providers that are part of an insurance company’s “network”

  • If you visit in-network providers, the insurance company will typically cover a larger portion of the cost of the care you receive. If you visit someone who is not part of the network, known as an out-of-network provider, the insurance company may pay for a portion of the care, but you will pay a significantly larger share from your own pocket.

Lifetime Maximum– The maximum amount that an insurance plan will pay toward care for an individual or family (if you have an applicable family plan)

  • This is not a per-year maximum, but rather a maximum that can be paid over the entire life of the patient.

Limitations/Exclusions– A list of all the procedures an insurance policy does not cover

  • Coverage may limit the timing or frequency of a specific treatment or procedure (only covering a certain number within a calendar year), or may exclude some treatments entirely. Knowing the limitations and exclusions of a policy is very important.

Member/Insured/Covered Person/Beneficiary/Enrollee– Someone who is eligible to receive benefits under an insurance plan

Provider– Drs. Kaye, Tushman, Goldstein, Jacobs, Wexler, Novison, and Salaverry or other oral health specialist who provides treatment

Waiting Period– A specified amount of time that the patient must be enrolled with an insurance plan before it will pay for certain treatments; waiting periods may be waived if you were previously enrolled in another dental insurance plan with a different carrier

There are many different insurance options available, so you need to find out exactly what your insurance covers. It’s important to review your plan with a qualified insurance specialist. Don’t be afraid to ask questions about the policy so you can understand it fully and be confident that you know everything your policy covers the next time you come in for treatment at our New York, NY office.

Tooth Protection and Winter Sports

January 2nd, 2019

Just because it’s cold out there doesn’t mean you’ll give up keeping fit and active! Winter is the season for some of our favorite team sporting activities, and when you’re donning your protective gear, don’t forget to protect your teeth as well.

  • Basketball

This sport actually tallies one of the highest counts of dental injuries. Running, jumping, and diving for the ball on an unforgiving court can lead to tooth and jaw injuries.  And for every ten men on the floor, it seems like there at least 50 flailing elbows in the paint.

  • Hockey

Notorious for the toll it takes on teeth, hockey is a game of sticks, ice, and whizzing pucks. And when your sport’s penalties include the terms hooking, slashing, and tripping, the more protection, the better.

  • Skiing

When you are flying down the slopes, combining powdery snow and speed, mouth protection is a good idea. This also applies to snowboarding and other snow sports.

  • Wrestling

Grappling and pinning in close quarters can lead to unintended injuries after accidental contact with the mat or your opponent.

Different uniforms, different equipment, and different playing fields, but all these sports have one thing in common—the easiest way to protect your teeth while playing them is with a mouth guard.

Mouthguards generally come in three forms:

  • Over the counter, ready-made appliances. These are available in drugstores and sporting goods stores, but might not be a comfortable fit as they are pre-formed sizes.
  • The “boil-and-bite” option is a mouthguard form placed in hot water. You then bite down to shape it to your mouth and teeth.
  • Custom mouthguards can be fabricated just for you through our New York, NY office. These appliances are designed to fit your individual mouth and teeth, so provide a better fit and better protection. They are also usually more durable and more comfortable. If you wear braces, you definitely need a custom mouthguard to prevent an injury to your mouth or braces caused by an ill-fitting appliance.

Whether you play on a team or pursue individual athletic activities, keeping safe as you keep fit is your first priority. We would be happy to discuss your mouthguard options for any sport, any time of year.

Smile, the New Year is Almost Here!

December 26th, 2018

We’ve been celebrating the new year for a really, really long time. It goes way back, but it started formally in 1582, when Pope George XIII made January 1st the official holiday for ushering in the new year. The idea was to yell, cheer, and blow horns to scare away all the evil spirits of the previous year with the hope that the new one would be filled with happiness and opportunity.

While scaring away evil spirits isn’t what’s on our mind these days, we still ring in the New Year by cheering and hollering with friends and family. It’s a time to set new goals, refocus on old ones, and look forward to all the surprises the coming year will bring.

Whether you’re saying hello to the New Year snuggled up at home on your couch in the New York, NY area or by gathering your friends for a social celebration, here are some tips to help ensure you welcome this new chapter with a smile.

Tips for a great New Year’s Eve celebration from Kaye Dentistry

  • Stay safe. This one’s vital, because nothing puts a damper on your party like an emergency trip to the hospital. Stay responsible and try to plan ahead, whether that means taking a taxi, staying with a friend, or recruiting a designated driver. Do what you have to do to keep yourself and everyone around you safe.
  • Spend time with the people you love most. The way we see it, the whole point of the holiday season is to cherish your family and friends. Regardless of what you’re doing, make sure there’s something for everyone. It’s essential to do something the whole group will enjoy!
  • Smile! Whether you get all dressed to go out or have a quiet gathering with family and friends, make sure you accessorize with a smile. There’s always something to smile about!

We can all agree that change can be scary sometimes, but ringing in the New Year is an observance we all welcome with open arms. We hope you’ll enjoy this transitional holiday in a fun, healthy, and safe way. You have endless possibilities ahead of you!

From Drs. Kaye, Tushman, Goldstein, Jacobs, Wexler, Novison, and Salaverry, have a fantastic New Year!

How effective is whitening toothpaste?

December 19th, 2018

The American Dental Association encourages you to brush your teeth twice a day with fluoride toothpaste to prevent dental problems such as tooth decay, bad breath, sensitive teeth, and gingivitis.

Beyond these health effects, frequent brushing of your teeth with a high-quality toothpaste can keep your teeth white. If you desire a whiter smile without in-office bleaching at our New York, NY office, use of a whitening toothpaste is a great option for you.

Why Consider Whitening Toothpaste

Whiter teeth are more attractive and can help you feel confident in your smile. Having a whiter smile and greater self-assurance can send the message that you take care of yourself and are confident in your abilities.

How Whitening Toothpaste Works

Although every toothpaste has whitening properties because they all help to remove food particles from your teeth, the American Dental Association says whitening toothpaste must contain certain chemicals that help remove stains.

Unlike bleaching products, which contain carbamide peroxide or hydrogen peroxide, whitening toothpaste only cleans the enamel rather than changing the color of your teeth. To obtain the benefits of whitening toothpaste, you need to use it regularly.

The Effectiveness of Whitening Toothpaste Varies

Due to individual variations in the color of your teeth, certain people are more likely than others to achieve the desired results with whitening. Teeth that are tinted grayish are unlikely to respond well to bleaching, while brown teeth may sometimes respond, and yellowish teeth are most likely to become pearly white in response to bleaching.

If Drs. Kaye, Tushman, Goldstein, Jacobs, Wexler, Novison, and Salaverry and our staff believe that bleaching is not a viable option for you, proper oral hygiene and the use of a whitening toothpaste are your best bets for keeping your teeth as white as possible. In addition, avoid using tobacco products, and rinse your mouth after drinking coffee.

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