07.03.09 Issue #382 Forward This Newsletter To A Colleague

Carol Tekavec
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Possible New Income Streams: SCHIP and Implants

The recent federal reauthorization of SCHIP (State Children’s Health Insurance Program) may have a bearing on the future coverage of dental care for many children in your community. According to the legislation, SCHIP includes a dental benefit guarantee for the first time. In addition, oral disease prevention services and restorative and emergency care for children who do not have private dental insurance is included.  According to the organization, Oral Health America, the department of Health and Human Services will be working with states and dentists to set up lists of covered benefits and willing dental providers.

The type of coverage offered will apparently be based on “benchmarks” in order to identify adequate plans. These benchmarks include: the dental plan chosen by most state employees with dependents, the dental coverage most often selected by federal employees with dependents, or the largest non-Medicaid private dental plan in the state. In some states Delta Dental is handling the program.

Currently there is a web site, www.insurekidsnow.gov and a phone number (877)KIDS-NOW, where information is available. Each state will offer its’ own plan, however, most of the states will be offering uninsured children through age 18, free or low-cost dental insurance. Typically the child must be a member of a family of four or more that is earning less than $34,100 a year. Many of the states will also offer insurance that pays for physician visits, prescription medicines, hospitalizations, eye care and medical equipment.  An important distinction is the fact that children who fall under guidelines making them eligible for Medicaid, even if they are not actually on Medicaid, are not going to be eligible for the SCHIP coverage.

Why does this matter to you? Some practices are looking to supplement their current patient pool. Whether you have dealt with Medicaid in the past or not, SCHIP is not Medicaid. The SCHIP plan might fit into your practice and provide an additional income source. To find out more about participating as a dental practice, you may contact your state children’s health insurance department or the numbers previously listed in this article.

According to Dr. Gordon Christensen, more general dentists should be providing their patients with implants. His estimate is that only 5-15% of dentists are placing them now. During the ADA Meeting last October, Dr. Christensen was quoted as saying:

“There are many things that are more aggressive and more threatening than doing an implant in a healthy person with good bones. It’s simpler than doing a third molar extraction.  There is far more legal activity around third molar extractions than in implants.”

Mini-implants are technique sensitive, as just about anything in dentistry is, but very patient friendly. If one fails, another can be placed without much trouble. If you have been holding off on providing implants in your practice, now might be the time. 

Once you are ready, arm yourself with answers to the most common questions that your patients will likely ask you about implants and what they can mean to them. Be prepared with simple, yet effective responses. You want to maintain a positive tone, but you also want to be completely “above board.” It is important that you and your staff are on the same page concerning how you present information about implants. A good patient education brochure can back up your explanations while being very inexpensive.  Remember, educated patients say “yes” to treatment.

Here are some examples, excerpted from my brochure Implants and Others…When Teeth go Missing:

Q) How do I know if I am a good candidate for implants?

A) A person needs to have enough bone to hold an implant in place. If your bone is not thick enough you can still get an implant, but a bone graft may be needed first. Severe, ongoing periodontal disease may also be a problem, as may a traumatic bite and smoking. Certain systemic health conditions must also be taken into consideration. 

Q) Will my insurance pay for my implants?

A) More and more dental insurance plans are including implants in their contracts within the confines of applicable yearly maximums. Under some contracts, even if the implants are denied, the crowns or bridges placed on top of them may be covered. Implants are popular and effective. We can help you file your claim to get the best coverage for which you are eligible.

Now, more than ever, dentists need to be aware of any possibilities for better treatment for their patients and more income for themselves. SCHIP reauthorization and the popularity of implants are two unrelated, yet potential, sources of increased income for the practice.

Carol Tekavec CDA RDH is the president of Stepping Stones to Success, and a practicing clinical hygienist.  She is a consultant to the ADA Council on Dental Practice and was the insurance columnist for Dental Economics for 11 years.  She is also the author of the Dental Insurance Coding Handbook and the creator of the “First Encounter™” Chart.  

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