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Navigating the World of Dental Insurance Terminology

November 30th, 2022

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 San Antonio Oral & Maxillofacial Surgery Associates, P.A.. 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 Dr. Mazock, Dr. Salazar, and Dr. Coleman, 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– Dr. Mazock, Dr. Salazar, and Dr. Coleman 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 San Antonio or Castroville office.

Thanksgiving in North America

November 23rd, 2022

Thanksgiving marks the start to the holidays; a season filled with feasting, indulging, and spending time with family and friends are always special. Thanksgiving is a holiday meant for giving thanks, and while this may seem like such a natural celebration, the United States is only one of a handful of countries to officially celebrate with a holiday.

Unlike many holidays, Thanksgiving is a secular holiday, and it is celebrated on the fourth Thursday in November in the United States. In Canada, it is celebrated on the second Monday of October, which is, oddly enough, much closer to a time when harvests were likely gathered. In addition to the different dates, the origins of the celebration also share different roots.

Thanksgiving in the United States

Giving thanks for a bountiful harvest are not new, but the modern day holiday in the US can be traced to a celebration at Plymouth in Massachusetts in 1621. This feast of thanksgiving was inspired by a good harvest, and the tradition was simply continued on. At first, the colony at Plymouth didn't have enough food to feed everyone present, but the Native Americans helped by providing seeds and teaching them how to fish, and they soon began to be able to hold a feast worthy of the name. The tradition spread, and by the 1660s, most of New England was hosting a Thanksgiving feast in honor of the harvest.

Canadian Thanksgiving

An explorer of early Canada named Martin Frobisher is accredited for the first Canadian Thanksgiving. He survived the arduous journey from England through harsh weather conditions and rough terrain, and after his last voyage from Europe to present-day Nunavut, he held a formal ceremony to give thanks for his survival and good fortune. As time passed and more settlers arrived, a feast was added to what quickly became a yearly tradition. Another explorer, Samuel de Champlain, is linked to the first actual Thanksgiving celebration in honor of a successful harvest; settlers who arrived with him in New France celebrated the harvest with a bountiful feast.

A Modern Thanksgiving

Today, Thanksgiving is traditionally celebrated with the best of Americana. From feasts and football games to getting ready for the start of the Christmas shopping season, Thanksgiving means roasted turkey, pumpkin pie, and green bean casserole. No matter how you celebrate this momentous day, pause for a moment to give thanks for your friends, family, and all the bounties you’ve received. Happy Thanksgiving from San Antonio Oral & Maxillofacial Surgery Associates, P.A.!

Dental X-Rays: Are They Safe?

November 16th, 2022

X-rays have been a function of dental healthcare for a long time. That in and of itself should be good news, because it means we've had plenty of time to improve them. While there is always some risk in exposure to radiation, dental X-ray exposure has decreased significantly due to all the advances in technology. So there’s risk, but X-rays are quite safe.

Think of X-rays as you would about a car. Automobiles these days have all kinds of technology to make them as safe as possible. There's still a chance that you’ll suffer an accident. Would you stop using a car because of that risk? When it comes to dental X-rays, Dr. Mazock, Dr. Salazar, and Dr. Coleman and our team believe the positives clearly outweigh the negatives.

X-rays can be done digitally or with film. For film, X-rays require different exposures at different speeds to produce the image. Digital X-rays have software that automatically adjusts the exposure and produces the X-ray in a digital file. Since they substantially reduce your exposure to radiation, digital X-rays are the current standard in dental offices.

In addition to digital X-rays, lead aprons are an essential piece of X-ray safety. They help protect internal organs from X-rays by acting as a shield. They usually come with a thyroid collar as well, since that is one of the most vulnerable areas to X-rays in the body. Lead aprons can absorb up to 95% of any scatter rays that result from an X-ray. Not bad, right?

Although dental X-rays involve some radiation exposure (not all of it can be eliminated), so does everyday life. Getting too much sun, for example, can be dangerous. The truth is, we accumulate radiation in our bodies over a lifetime, so it’s worthwhile to be aware and avoid as much unnecessary exposure as possible. When it comes to your dental health, though, getting an X-ray — especially when your doctor says you need it — offers more benefits than risks.

Ask us about the type of dental X-rays we use during your next visit to our San Antonio or Castroville office!

Will Insurance Cover Dental Implants?

November 9th, 2022

Dental implants are an increasingly popular choice when we need to replace a lost tooth or teeth. The reasons for choosing an implant are clear: implants look just like our natural teeth, are firmly anchored in the jaw just like our natural teeth, and are easy to clean and care for just like our natural teeth.

Not as clear? Whether your insurance will cover your implant procedure. Because implants are often more expensive than other replacement options, it’s important to learn just what your insurance plan provides, and what your out-of-pocket expenses will be. What do you need to know?

Know your policy

Dental and medical plans vary widely, from individual to individual, company to company, and state to state. Depending on your specific policy, you might be covered for part or most of the cost of a procedure, or your plan may provide no coverage at all. It pays to find out ahead of time!

Know the reason for your procedure

Your coverage may be affected by the reason for your procedure and whether it’s seen as medical or dental.

  • If your dental insurance policy considers an implant to be a cosmetic or an elective treatment, implant surgery may not be covered. However, the cost of the crown restoration could be, at least in part.
  • If implants are used to anchor a bridge or a denture, your dental policy might provide partial coverage, at least to the monetary extent that the insurance company would cover standard bridges or dentures.
  • If you are suffering medical complications because of tooth loss due to illness, accident, or injury, your medical health insurance could cover some of your expenses.

 Know your plan’s annual and lifetime limits

If you do have dental coverage, there might be limits imposed on the kind and number of procedures allowed during a calendar year. You could also have yearly maximum benefits or lifetime maximum benefits, after which your expenses will be out-of-pocket.

Find out which steps of the implant procedure are covered

The implant process can require different steps, some of which may be covered by insurance while others are not. Depending on your needs, these steps can include:

  • Extraction
  • Bone grafting
  • Implant surgery
  • Crown restoration
  • Anesthesia

Your policy may or may not cover any of these individual procedures, so it’s always best to discover exactly what’s involved in your implant treatment before you begin.

Know how to find out what you need to know!

  • Talk to our San Antonio or Castroville office before you schedule surgery. Oral and maxillofacial surgeons are experts in implant procedures, and can provide you with an explanation of just what services will be involved at every stage of your implant treatment, as well as a pre-treatment estimate.
  • Talk to your dental insurer to see exactly what coverage they provide for the procedure or procedures you might need.
  • And don’t forget to touch base with your medical insurer if you need implants as the result of a medical condition, accident, or injury.

Finally, talk to Dr. Mazock, Dr. Salazar, and Dr. Coleman again! We want to make sure that you receive all of the coverage that you are entitled to, and that your implant procedure is as affordable as it can be for this lifetime investment in your oral health. Whether it’s working with you to make the most of your insurance coverage, or working with you to discuss a financing plan that fits your budget, we will do their best to provide the clear answers you need.

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