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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 Pediatric Dental Health Associates, Ltd. 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. Joanne Oppenheim, Marilia Montero, and Mary J. Hayes, 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. Joanne Oppenheim, Marilia Montero, and Mary J. Hayes 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 Chicago office.

Snacks can taste good and give your child’s energy a boost, but they can also be bad for teeth. Sugary, sticky snacks, such as candy, cookies, and snack cakes can lead to tooth decay if eaten regularly between meals. Still, there are plenty of fun snacks for healthy teeth.

The trick when selecting snacks is to avoid too many added sugars and refined carbohydrates that stay on the teeth and give bacteria a chance to ferment and produce acid from them, which can lead to tooth decay. In addition, snacks should provide nutrients to support a healthy mouth. These are five fun snacks you can feel good about giving to your child.

1. Yogurt and cereal.

Yogurt contains calcium, which is an essential mineral for strong and healthy teeth. Select plain yogurt or yogurt flavored with real fruit, rather than flavored yogurt that is sweetened with added sugar. We recommend choosing a whole-grain cereal, which is less likely to lead to dental caries. Choose a low-sugar or unsweetened cereal to avoid accidentally making the snack as sugary as a candy bar.

2. Tuna and whole-wheat crackers.

Canned tuna contains vitamin D, which is an essential vitamin for helping your body absorb and use calcium. Whole-wheat crackers are natural sources of antioxidants for a strong immune system, and they’re lower in refined carbohydrates than white crackers.

3. Bell pepper strips and hummus.

Red, yellow, and green bell peppers are excellent sources of vitamin C, which is an antioxidant. Vitamin C is also a good choice for supporting regeneration or maintenance of healthy gum tissue. Vitamin E is another antioxidant, and it also supports a healthy immune system. A strong immune system is protective against infections, such as bacterial infections associated with gum disease.

4. Turkey and cheese roll-ups.

Turkey is carbohydrate-free, so it doesn’t leave residues of sugars on teeth for bacteria to ferment. Lean ham is another good choice. Low-fat cheddar, mozzarella, or Swiss cheese is a good source of calcium as well as protein. For a more substantial snack that’s still low in carbohydrates and sugar, add a few celery sticks.

5. Peanut butter and carrots.

Peanut butter is another source of vitamin E. Carrots provide vitamin A, which is essential for a strong immune system. You can also substitute cauliflower or broccoli florets for the carrots, and ranch dressing for the peanut butter, and still have a snack that’s fun to eat and good for your child’s teeth.

For more great snack tips, ask a member of our Chicago team at your child’s next appointment!

How better to spend the fall months than inside by the fireplace with a warm cup of cider and a book in hand? Drs. Joanne Oppenheim, Marilia Montero, and Mary J. Hayes and our team at Pediatric Dental Health Associates, Ltd encourage you to warm up your mind this fall season with a few great books. Sure it may be easy to put off reading when balancing a hectic schedule, but reading is vital to brain development. Besides, reading is always a blast!

This week, we thought we’d ask what you or your child are reading this fall. Do you have any suggestions for must-read books this year? Out of ideas for great fall reads? Ask us for suggestions, and we would be happy to provide a few. You may also ask a local librarian here in Chicago for some ideas.

Happy reading! Be sure to share with us your fall picks or your all-time favorites below or on our Facebook page!

Drs. Joanne Oppenheim, Marilia Montero, and Mary J. Hayes, as well as our team at Pediatric Dental Health Associates, Ltd, would like to give those patients with flex spend, health savings, or insurance benefits a friendly end of the year reminder that it’s high time to schedule your dental visits so you optimize your benefit.

Now is the time to reserve your appointment with us. Space is limited and we tend to get busy around the holidays, so don’t wait to give us a call at our convenient Chicago office!