HOW DOCTORS ARE PAID IN THE 21st CENTURY
In the 21st Century, what payment options do you have for health services? Most of the time, those of us who may have health insurance simply present some ID, and we are instantly received with open arms and the mention of a possible "co-pay". Though very convenient, it is important that you understand what is happening in the "back room".
Doctors used to rely on a good track record, a good reputation, and word of mouth to be successful. Today, networks, and affiliations determine the success of many healthcare providers. You can be the worst doctor, but if you have a good business machine and a computer, you can make tons of money, even though your patients may not be getting the best care you can give them. In a large number of offices, you will spend much more time in the waiting room (holding pen), than you will spend interacting with the doctor. Many offices have an unstated mission to see the largest number of patients for the least amount of time possible. That is why you feel like a number, or a piece of meat. That is why the doctor will not even listen to you long enough to get an adequate history out of your mouth, or answer any questions you may have. Let me explain the history behind this behavior.
In the late 70's and early 80's, the health insurance cartel, and the provider healthcare associations (read between the lines please), decided that they needed to devise a way to make healthcare, and healthcare insurance more affordable. The was the beginning of the "maintenance" organizations (HMO, and dental DMO respectively). These were managed care initiatives that were designed to save your insurance carrier money, and fill the pockets of doctors with the premise of maintaining your health. The design was that if doctor X is paid a fixed rate by the insurance company for each patient, he would have an incentive to keep them well. Sounds good so far. Picture this! Dr. X enters into a contract with insurance company Y to service their subscribers. Dr. X gets $1000 per year and must fulfill all the dental needs of each subscriber. Subscriber Z needs a molar root canal. The average cost of this treatment is between $900 and $1200. The doctor is contractually obligated to fix your problem. His options are to break the contract and charge you more, and you will object and maybe report him, or he will have to absorb the loss. His motivation is either to ignore the problem, ameliorate it with a prescription which does not solve the problem but will maintain your comfort level for some time. Bottom line is you (the PATIENT) become the tool or pawn of the insurance company and the doctor who has become the contract employee of the insurance company. The doctor should be the PATIENT'S employee. I serve you first, not your insurance carrier. My contract must be with you in order for me to have the proper motivation to treat you well. In the last 10-15 years many good doctors have opted out of this triangle of allegiances to you and the insurance cartel, because they realized that they were no longer practicing medicine or dentistry, but were simply money machines who would be sanctioned if they went against the wishes of the insurance industry to give you better service. Can anybody hear what these written words are suggesting?
Now in all fairness, I must say that this type of situation has been cleaned up and corrected to some extent. However, when dealing with my body, I would like to feel that the doctors contract is with me first, and that he will be paid because he is a good doctor, not because he is a slick business man. There is the disconnect. I must want to do what is right for you and expect to be paid honorable for that treatment. You (the PATIENT) should never become irrelevant, thought of as redundant, or subordinate to my wallet, or the insurance companies war chest. It simply keeps me honest when my agreement and contract is with the PATIENT first.
DENTAL INSURANCE COVERAGE AND DISCOUNTED DENTAL PLANS
Dental insurance is a type of health insurance designed to pay a portion of the costs associated with dental care. There are several different types of individual, family, or group dental insurance plans grouped into three primary categories: Indemnity (or sometimes called: true dental insurance) which allows you to see any dentist you want who accepts insurance, Preferred Provide Network dental plans (PPO; briefly discussed below), and dental Health Managed Organizations (DHMO) in which you are assigned to an in-network dentist or in-network dental office and must stay within that network to receive your dental benefits.
Generally dental offices have a fee schedule, or a list of prices for the dental services or procedures they offer. Dental insurance companies have similar fee schedules which is generally based on Usual and Customary dental services, an average of fees in your area. When a dentist signs a contract with a dental insurance company that provider agrees to match the insurance fee schedule and give their customers a reduced cost for services, this is considered an In-Network Provider or Participating Provider network (PPO). Depending on your specific plan, if you seek an Out-of-Network or Non-Participating Provider, any difference of fees will become the financial responsibility of the patient unless otherwise specified in your dental policy. Some dental insurance plans may have waiting periods. This is a period of time before certain benefits will be covered. Generally set in place when you are a new enrollee or seek out an independent plan outside of an employer or group policy.
Some dental insurance plans may have an annual maximum benefit limit. Thus, once the annual maximum benefit is exhausted and additional treatments may become the patient's responsibility. Each year that annual maximum is reissued. The reissued date may vary as a calendar year, company fiscal year, or date of enrollment based on your specific plan. Orthodontics usually has a separate limit. Some plans may have an annual deductibledepending on the type of treatment rendered. After the deductible is met, the remaining dental plan benefit is paid at its specified percentage or fee schedule.
In the New York Tri-state area, most PPO plans allow you to choose the dentist or dental facility of your choice, whether in-network, or out-of-network. That being the case, if you have a PPO dental plan, you can use this coverage up to your specific service maximums and your annual maximums (both determined by your union or insurance carrier).
Having said all the above, this practice has the following payment options and procedures.
If your dental PPO is a high option plan, it may cover our fee in full, in which case we will
accept the insurance payment as full payment. If the insurance payment is less than our
fee, the patient must then remit the balance to Dr. Clifton. Our desire is to reduce or eliminate out-of-pocket costs to you as much as possible.
Flex Medical/Health Spending Plans or Swipe Cards can be accepted at our office as
SOME WORDS ABOUT IMPLANTS
The following is a very good explanation of what implant dentistry is in this last decade.I feel that this material, which can be found on the internet, gives a clear, concise presentation that can be understood by patients who desire to investigate implant dentistry.
Stage 1: Placing the implant fixture
The implant fixture is the portion of the dental implant that lies below the gum line and acts as the artificial root for the new replacement tooth. It is a titanium screw that is surgically placed into the jawbone. It is left untouched for several months while the surgical site heals and the dental implant anchors itself to the surrounding bone, a process known as osseointegration.
Stage 2: Placing the abutment
Once the implant site has healed and the implant fixture is osseointegrated into the surrounding bone, a post or "abutment" is placed into the implant. The abutment is usually screwed into the implant fixture about four to six months after the implant was surgically placed by the implant dentist. The abutment protrudes above the gum line and supports the final crown.
Stage 3: Placing the final crown
After the abutment is placed, an impression is taken and sent to a dental laboratory where a porcelain or porcelain-fused-to-metal crown is fabricated. The crown is returned to the dentist who then permanently cements it onto the abutment
This is a file of "Chicken Soup" items found in a file on my computer:
1) AMALGAM>>>>>>>>SELENIUM FOR HEAVY METALS AND NEURO-DEGENERATIVES
Anyone at risk of mercury poisoning should supplement his diet with selenium, which is a natural neutralizer of mercury. We strongly recommend the high quality selenium that is found at health food stores, but not general retailers. Selenium neutralizes some toxic heavy metals; especially mercury and aluminum. Our research shows that selenium alone will prevent most so-called "age related" degenerative brain diseases. These diseases are, in most cases, lifelong heavy metal accumulation and toxicity. They are simple cases of poisoning, and the victims are not really diseased. Preventing the brain damage with selenium is tremendously easier than reversing it, which can be impossible.
2) Vitamin C when taken internally actually strengthens teeth, and the rest of the body. However, it should never be kept in direct contact with the teeth. We strongly recommend for those who are brushing their teeth with citrus formulas to discontinue immediately. Fluoride-free toothpastes which contain calcium carbonate are ideal for long-term dental health, and whiteness.
3) Fructose causes a decrease in phosphorus, which is one reason why "sugar" seems to cause cavities. Technically, sugars and carbohydrates can be harmful too, but the greatest damage is due to the connection between phosphorus depletion and the intake of fructose. This is often missed by "the experts".
4) Those suffering from periodontal diseases such as gingivitis should look in the direction of CoQ10. Those who suffer from gum diseases are invariably deficient in co-enzyme Q10. It has shown good success with topical application, and so mouth rinses are now available with this ingredient. In addition, coQ10 is created by the body during exercise.
5) The average pH of soft drinks is 2.5, while the mouth should remain about neutral, or a pH of about 7. For decades, it has been believed that merely the low pH of soft drinks was the causative factor in weakened tooth enamel, and that the teeth should be immediately scrubbed clean after consumption. Contrary to what has become the popular belief, waiting at least a half hour to an hour before brushing, and using a "soft" tooth brush leads to the best overall dental health. This window in time just after a sugary snack or drink is the period that tooth enamel is in it's softest state in that first hour. If you brush vigorously or with something other than a soft bristle brush immediately after eating, you can lose much more enamel from the tooth surface, which leads to erosions and sometimes soft areas of your teeth. This is not the "decay" process but is a similar process where an acidic environment can significantly damage your teeth. Rinsing with water (not mouthwash or other additives) is excellent and a cheap way to address this issue. Don't brush, just rinse and reduce the oral acidity easily and gently.
FOR PARENTS OF SMALL CHILDREN
The following chart shows when your child's primary teeth (also called baby teeth or deciduous teeth) should erupt and shed. Eruption times vary from child to child.
As seen from the chart, the first teeth begin to break through the gums at about 6 months of age. Usually, the first two teeth to erupt are the two bottom central incisors (the two bottom front teeth). Next, the top four front teeth emerge. After that, other teeth slowly begin to fill in, usually in pairs -- one each side of the upper or lower jaw -- until all 20 teeth (10 in the upper jaw and 10 in the lower jaw) have come in by the time the child is 2 ½ to 3 years old. The complete set of primary teeth is in the mouth from the age of 2 ½ to 3 years of age to 6 to 7 years of age.
Primary Teeth Development ChartUpper TeethWhen tooth emergesWhen tooth falls outCentral incisor8 to 12 months6 to 7 yearsLateral incisor9 to 13 months7 to 8 yearsCanine (cuspid)16 to 22 months10 to 12 yearsFirst molar13 to 19 months9 to 11 yearsSecond molar25 to 33 months10 to 12 years Lower Teeth Second molar23 to 31 months10 to 12 yearsFirst molar14 to 18 months9 to 11 yearsCanine (cuspid)17 to 23 months9 to 12 yearsLateral incisor10 to 16 months7 to 8 yearsCentral incisor6 to 10 months6 to 7 years
Other primary tooth eruption facts:
Shortly after age 4, the jaw and facial bones of the child begin to grow, creating spaces between the primary teeth. This is a perfectly natural growth process that provides the necessary space for the larger permanent teeth to emerge. Between the ages of 6 and 12, a mixture of both primary teeth and permanent teeth reside in the mouth.