Poking Wires, Broken Brackets and All That Stuff!

Anyone that has had or has braces knows that it is not uncommon to have a poking wire or a broken bracket at some point during treatment. While they can be bothersome and annoying, it is no reason to panic. Poking wires often occur when the wire shifts due to tooth movement or broken brackets. Fortunatley, poking wires can usually be easily fixed by reinserting the wire into the tube on the bracket by using a pair of tweezers to grasp the wire and carefully placing it into the tube. If you are unable to reinsert the wire, you also have the option of clipping the wire with a pair of nail cutters that resemble cuticle cutters. You just need to clip the wire as close as you can to where it connects with the last tooth that it is attached to. By doing this, you can temporarily provide comfort and alleviate the pain that can be caused by poking wires.

Insurance and Braces - Are You Covered?

As anyone with braces can tell you, orthodontic treatment can be very expensive, but dental insurance can help. The trick to getting the most out of your insurance begins with understanding how orthodontic insurance works.

To begin, there are usually limitations on how much orthodontic coverage a person is eligible for. Typically, coverage is limited to 24 months of treatment with an HMO. HMO's also have limitations on which doctor you can see, as they will not pay for treatment if you do not go to one of their participating providers. Fortunately, Dr. Eder participates with most of the major companies and is experienced in jumping through their hoops, to get the most benefit for the patient. This often includes sending in a pre-authorization request before the patient begins treatment.

PPO's on the other hand, usually have Lifetime Maximum payouts. What this means, is that they will only pay a limited amount towards braces, throughout the patient's lifetime. The most common lifetime maximums offered range from $1000 to $1500, but there are plans out there that will pay as little as $500 to as much as $3000. With a PPO plan, you do not have to see an in-network dentist, but you probably won't receive the discounted rates that participating providers usually offer, and once you have used your benefit maximum, you are responsible for all  outstanding charges.

Both the PPO and HMO plans have fee schedules that participating providers must follow when treating patients covered by their respective plans. In most cases, there are some nice discounts, but depending on the plan, they may limit how often a certain procedure may be covered.

Another nice thing about PPO's that differs from an HMO, is that a PPO will usually coordinate benefits with a secondary insurance benefit. Unfortunately, most HMO's will rarely coordinate benefits with another insurance company, unless they are the primary insurance and the PPO is the secondary insurance.

So how do you know which insurance is the primary and which is the secondary insurance when you are covered by 2 insurance policies? With children, the parent whose birth date comes 1st in the year is the primary and the other subscriber whose birthday is later in the year is the secondary. Please note that this does not include the birth year, only the month and day. Which means that if mom's birth date is 6/5/59 and dad's birth date is 7/5/49, mom is the primary and dad is the secondary because mom has her birthday first in the year. There are also exceptions to be made when people share a birthday or when a court orders a certain parent be responsible for primary coverage. When referring to adult coverage, if you have coverage through your employer, you are the primary and your spouse's insurance is your secondary insurance.

To complicate matters even further, insurance companies may  also include a non-duplication clause, which will limit what the secondary insurance pays. In most cases, it means that the secondary insurance company will not pay more than the primary insurance company will pay. So if your primary insurance coverage is for 50% of a procedure up to $1000 maximum and your secondary insurance company benefits are the same 50% up to a maximum of $1000, then the second insurance company will not pay anything towards the procedure. However if the secondary insurance coverage is 80% up to a maximum of $1000, then you should get the benefit of the extra 30% coverage and the secondary company should pay an additional $300.

There are many other situations and clauses that may arise when dealing with dental insurance and orthodontics in particular. One of the main concerns that many people have, has to do with is how and when the insurance company pays for orthodontic treatment. In 99% of the cases, the insurance company will pay for their share of the orthodontic treatment throughout the period that the patient has braces. So if the patient is scheduled to have braces for 24 months, the insurance company will make payments to the doctor, spread out throughout the 24 month period. Unfortunately, this means if you cancel your insurance or lose coverage before the braces are scheduled to come off, the primary subscriber (or patient) is now responsible for paying the doctor whatever amount the insurance company failed to pay.

If you are interested in finding out about your insurance benefits, it is often best to speak to your Human Resource office at your place of business when possible. If it is not possible, I recommend calling the customer service number on the back of your insurance card and asking them to explain your benefits. However, please remember that these customer service representatives are human and can make mistakes, and they will remind you that all benefits quoted over the phone are not a guarantee of coverage. With that said, at Dr. Eder's orthodontic office, we pride ourselves in going that extra mile to help you understand your coverage. To set up an appointment for a Free Consultation, and to have your insurance questions answered please call (561) 737-8776.

Building Relationships at Eder Orthodontics

At Eder Orthodontics, Dr. Eder and his staff pride themselves in building relationships with patients that often lasts long after the braces have come off and orthodontic treatment has been completed. It is not unusual to have patients stopping by just to say hello, even after getting their braces off years earlier.

It is also not unusual for parents to come in for orthodontic treatment after their children are out of braces. The amount of trust that they have in Dr. Eder and the staff is something that we take very seriously and work hard to maintain. One of the greatest compliments that patients give our office, is the referral of their friends and family. Dr. Eder has even had a couple of patients that he treated as teenagers, grow up and start a family of their own and then bring their children for consultations. Now that's a compliment!

To find out more and to schedule a complimentary consultation, please call our office at (561) 737-8776.

Braces and Food- What Foods to Avoid

The holidays are a time of celebrations with friends and family and lots of good food. Temptations abound at holiday parties where bowls of mixed nuts, candies and chips are on every table. While it may be difficult to resist these temptations and pass on the chips and dip, it’s necessary if you want to avoid broken brackets and the poking wires that often accompany them.  This doesn’t mean however, that you can’t enjoy a very delicious holiday dinner with family and friends, it just means that you have to make careful selections when hitting the buffet table.

The following foods should be avoided if you don’t want to break a bracket:

·         Hard Candy – avoid all hard candy, including candy canes, lifesavers, Tic Tacs, breath mints, etc, because even if you think that you can resist the temptation to bite into it, chances are, you won’t.

·         Chewy Candy – avoid chewy candy of any kind, including Gummy Bears, licorice, caramels, Starburst, Taffy, etc, because they will stick to your teeth and if your bracket doesn’t break when you are eating it, chances are it will break when you are trying to get all the soft gooey stuff from between your teeth and from around the brackets.

·         Hard Gum or Gum with a Candy Shell – examples of the types of gum that should be avoided include Bazooka, Chicklets, Dentyne Ice, Gumballs, etc.

·         Nuts – doesn’t matter what type they are, pass them up now and avoid the broken brackets and extra visits to the orthodontist later to fix them.

·         Hard tacos, pretzels, popcorn or thick chips like Doritos – Just Say NO!!

·         Corn on the Cob - Cut if off and you should be okay.

·         Toasted Bagel, Pizza Crust or Hard Crusty Rolls – Opt for the soft rolls and you should be okay, but everything else needs to be avoided.

·         Chunky Ice Cream – This delicious treat has many hidden gems that can cause broken brackets.

·         Ice Cubes – It’s okay to have them in your drink, but not in your mouth! That includes ice chips too!