What is Personal Dental?

Personal Dental is BEST Life’s new line of dental plans.  These dental plans are sold through the BEST Employers Association (“BEA”) and are available directly to individuals and families residing in California. 

Personal Dental provides an affordable alternative and are designed for individuals not eligible for coverage on an employer plan. Dependent children who reach the age limit on an employer plan, or for individuals whose COBRA coverage has ended, may all purchase a Personal Dental plan.

Why choose Personal Dental?

As we’ve demonstrated in an earlier article, the cost of dental care can be expensive. Having dental insurance can help save you money and make it affordable for you to go to the dentist.

If you need dental coverage, live in California and are ineligible for group insurance,  Personal Dental may be the alternative you are looking for!

Personal Dental Plan Highlights: 

  • A selection of two indemnity plans that increase coverage over 2 to 3 years, and two scheduled reimbursement plans
  • No deductibles for preventive care
  • $50 yearly deductible for basic and major services
  • Coverage for preventive, basic and major services
  • Preventive care covered at 100% or 80%, or at a reimbursed amount
  • Coverage for sealants, fluoride treatment and space maintainers for children
  • Optional access to a PPO network of 18,359 dental offices in California 
  • Optional access to a national PPO network for children living outside of California or for those traveling

Where can I purchase Personal Dental?

Visit the Personal Dental website at www.beassoc.org/PersonalDental/ to download a brochure and application.  If you need assistance, visit http://www.beassoc.org/personaldental/directory.html to review a directory of insurance agents.  Just select the one nearest you and he or she will answer any questions you may have.

Why does the cost of health care services vary by zip code?

As you shop around for health care and dental services, you may notice that the cost for these services vary by zip code.  What one dentist would charge in one area for the exact same services, may be more or less what a dentist would charge in another area. What one hospital charges for services may be charged differently by another hospital.

 In this article, we explore why costs vary by zip code.

Demand and the Cost of Living

Location can mean everything. Many reasons can factor into why a residential area can be more expensive compared to others.  Here are just a few:

The cost of living can be more expensive in certain cities compared to others (think Beverly Hills, California vs. San Antonio, Texas).  Providing health or dental care may be more expensive because the property the office is built on is expensive, too. This can work the other way as well.

Population density: there may be more dentists/physicians per resident in well-populated areas, or just a few available in small towns. While health care providers may charge what is reasonable for their residents, they may charge slightly higher if there are too many patients that need their services.

Demand may be high: the health of a town’s population is a major factor. An unhealthy population would require more health care services, which could raise the costs of services for everyone. (Top 5 most expensive health care markets.)

The type of care available in your area. Hospitals and providers who specialize in a specific area of medicine or dentistry may require state-of-the-art technology, may be located in a more expensive area, or may just be high in demand.  It all depends what is available in your area.

What’s your doctor’s specialty? Specialists are health care providers or dentists that focus on treating one specific disease, illness, or region of your body. Services by a specialist may cost more because the treatment that is required may be more involved.  Your treatment may require the use of specialized software or technology, the use of an operating room, surgery, anesthesia, chemotherapy, etc.

General Dentists and General Physicians on the other hand focus on your whole being and on preventive care. This may work for your basic health needs, yet if your health changes, like expecting a baby, there may be a time when your health requires a specialist.

In most cases, your General Dentist or Physician will refer you to a specialist.

How can I save money?

There are several things you can do to save money:

If you can, use a PPO Network Provider. One easy way to save on your out-of-pocket costs is to select a provider in the BEST Life PPO network. Providers who participate in a BEST Life PPO network have agreed to accept a discounted rate for their services. Using a PPO Network Provider can save you anywhere from 5% up to 57%, depending on the service.  Our networks include general practitioners and specialists.

If you are on a medical plan, BEST Life offers a regional network specializing in providing care in your area, and PHCS Healthy Directions for services outside your area. 

Please note that the PHCS Healthy Directions secondary network is not available to PHCS members.  These members already use one of the largest national networks in the country.  PHCS Healthy Directions is available to Utah Beech Street members outside of Utah only.

Dental plan members have the option of using DenteMax (one of the largest national networks in the country) or, depending on their state and plan, a regional network. While BEST Life selects regional networks for the concentrated number of access points offered in a state, there may be situations where the DenteMax network can provide the needed extra access. 

Some areas of a state may have more providers participating in DenteMax’s network; a member who is traveling may need emergency care; or a member’s child is going to college in another state where the regional network is not offered. In all these examples, members can select a DenteMax provider and still save on their out-of-pocket costs.

Regardless of which network you use, always call the network provider and confirm that he or she is in the network before setting up an appointment. 

Always try to use your “In-Network Benefits”. If you are on a medical or dental PPO plan, going in-network will provide you with more coverage.  Your plan may cover a percentage more, you may have a lower co-pay or lower deductible, and in some cases preventive care may be covered 100%. 

Your Certificate of Insurance or Schedule of Benefits will provide you with the benefits and explain how your in-network benefits work.  Or, if you need assistance, you may contact our Customer Service Department and they can explain how your plan works. Contact Customer Service at 1-800-433-0088 or at cs@bestlife.com.

Shop around. The great thing about PPO and Indemnity plans is the freedom they give you to choose any medical or dental provider.  Now that you are aware of why health care costs may vary, shop around when you can.  If you are unhappy with the quality or cost of the service you received, you may select another provider at any time.

Keep in mind that a high price does not always equate to high quality.  Studies have shown that quality is not always the main factor driving costs.  For example, an Urgent Care Unit may not be the same as a hospital, but may provide less expensive and just as effective treatment for certain illnesses. (Read the Dartmouth Institute’s Study: Health Care Spending, Quality and Outcomes: More Isn’t Always Better.)

BEST Life lists a few non-affiliated websites you can go to for pricing (Treatment Cost Calculators), or you can always rely on recommendations from friends or from your favorite dentist or physician.

Do you really know your health plan?

Part 2. Other ways to save money on healthcare

These tips can help you save money

Learning how to use your plan can help you save money.

In our last post we talked about how important it is to understand how your plan works. In this post we will offer more tips and tools to help you save on your BEST Life plan.

Please keep in mind that this is for informational purposes only. None of this is intended to replace medical advice. Always consult with your physician before making any lifestyle changes that may affect your health.

Tip #4 Use your Preventive Care Benefits

If you are hesitating to make that appointment for a physical or dental exam, here are some very good reasons to pick up that phone and make that appointment: 

Getting a dental check-up twice a year really pays: The American Dental Hygienists’ Association estimates that every $1 spent on oral preventive care (meaning those cleanings and check-ups at least twice a year) saves $8 to $50 on restorative and emergency procedures.  Crowns and restorative dental work can be very costly.  Getting those check-ups may keep your oral health in check and may delay the need for restorative dental work.

Depending on your plan, preventive care may be 100% covered.  BEST Life’s plans are designed to make preventive care affordable for you and your family.  Many of our dental plans cover cleanings and routine exams every 6 months at 80% to 100% of the cost, depending on your plan. 

If you are on a Grandfathered Health Plan (that was purchased by your organization before April 1, 2010), an annual physical exam, routine screenings and flu shots are covered 100% up to $250 if provided by an in-network provider.  A Co-pay may apply, depending on your plan.

If you are on the new Non-Grandfathered Health Plan (that was purchased by your organization after April 1, 2010), a physical exam, routine screenings, and flu shots are covered 100% — no co-pays, no deductible and no coinsurance.

For exact details on what your plan covers, please refer to your Certificate of Insurance.

 It prevents costly diseases: According to healthcare.gov, an US government website dedicated to explaining the new healthcare reform, diseases like heart disease, cancer and diabetes account for 7 out of 10 deaths among Americans each year and 75% of the nation’s health spending.  All of these are diseases that can be prevented if treated in their early stages. 

A great way to catch a disease in the early stages is by getting an annual exam or dental check-up.

It helps you build a relationship with your doctor and your medical history: Medical history is vital to diagnosing a patient correctly. By getting an annual physical, your doctor can update your medical history and keep tabs on your health.  It also gives you a chance to discuss any health issues you may have.

 Tip #5 If it’s not an emergency, make an appointment with your doctor

Not only is care in an emergency room expensive, most are not equipped to handle routine illnesses.  Before you grab your car keys and head off to the nearest emergency room, ask yourself if you are better off waiting the next day to make an appointment with your doctor: 

 1.      Is it a true emergency?  Doctors in the emergency room first help those with the most life-threatening emergencies.  If your emergency is not as serious, skip the long wait and make an appointment with your doctor instead. 

 2.      Do you need a specialist? Emergency rooms may not be equipped with the right specialists you need.  If you are currently seeing a specialist, or if you have been going to the same doctor for years, make sure you discuss what to do in case of an emergency.  Your doctor may have a better way to address your needs. 

If you cannot reach your doctor, call the emergency room you plan on going to and confirm if they have the care you need.  If they do not, find out if there is another hospital or urgent care center nearby that can help you.

3.      When in doubt, call your doctor’s office. Your doctor may have a nurse on duty you can talk to.  A nurse can help you determine if your symptoms are serious enough to justify a visit to the emergency room.  If your doctor’s office cannot be reached, you can also try calling the emergency room you plan on going to.  Most have a triage nurse who can tell you if you need to come in.

Emergency care can be costly! Some BEST Life PPO health plans require you to pay higher co-pays than you would for a doctor’s visit.  This co-pay is waived if you are admitted to the hospital.  Even if your plan does not have co-pays, your plan will apply your deductible and then coinsurance to care that will be more costly than a routine visit to the doctor’s office. 

So if your illness is not a true emergency, save your money by making an appointment with your doctor. Save the emergency room for life-threatening emergencies.

Tip #6 Take advantage of the Treatment Calculators and other Health Tools we post on our website

We have posted Health Tools on the BEST Life website.  These are online tools, phone apps, treatment calculators and other sources that can help you save money on your health care.

 Here are a couple of highlights:

ICE 

This phone app provides first responders access to your key medical information in case of an emergency. It is free and available for download on the iPhone App store.

Medical Billing Advocates of America

Find an advocate to negotiate your medical bills or access this organization’s MyMedicalBill program and learn how to save on medical bills.

Healthcare Bluebook

Find fair prices for all your healthcare needs for surgery, hospital stays, doctor visits and more.

Capzule PHR

Carry your family history, track chronic conditions, store doctor appointments and more, all on your phone. A free version is also available for the iPhone.

PatientsLikeMe

Share your experiences on symptoms, treatments and more. This social network has been getting praise for how easy it is to find health-related information.

 

To see what else is available, visit the BEST Life website and click on “Health Tools”.

Do you really know your health plan?

Part 1. What you need to know about your BEST Life dental or health plan

You may not know it: your health plan has been designed to help save you money. Just by understanding how your plan works can save you anywhere from a few dollars up to a several thousand dollars depending on the treatment you receive.

We have separated our tips into two parts. We really have a lot of information to share with you and want to spend enough time on each tip. With that, we will start by talking about the information your BEST Life plan already provides you:

Tip # 1 Read your Benefit Summary
Your organization may have provided you with a Benefit Summary before you enrolled. If you did not get a Benefit Summary, request one either through your Benefits Coordinator or by calling Customer Service at 1-800-433-0088.

A Benefit Summary provides a short summary of what your plan covers and is a great tool to get familiar with your plan. While you read your Benefit Summary, make sure to notice the following:

  • In-network versus out-of-network:Services may be covered differently if provided by a healthcare provider contracted with a BEST Life PPO network. This type of plan is called a PPO plan. If you have a PPO plan, it is very important that you use an in-network provider. See Tip #3 for more on this topic.You have an indemnity plan if your plan does not separate benefits by in-network and out-of-network. While indemnity plans do not rely on networks, you still have the option to lower your out-of-pocket costs if you receive treatment from a provider within a BEST Life PPO network. Please read Tip #3 for more information.
  • What is covered under Preventive Care: If you have a Dental or Health plan, Preventive Care will include a list of services that will help keep you healthy. Because your health can change throughout the year, BEST Life’s plans can help make Preventive Care very affordable for you and your family.
  • How much does the plan cover for certain treatments: Understanding how much your plan covers for an expensive treatment will help you plan for the cost. In addition to cost, keep in mind that:
    • All of BEST Life’s dental plans require your dentist to get an estimate for any treatment that will cost over $500. (Called a Predetermination in your Certificate of Insurance.)
    • If you undergo a medical emergency, we offer case management services to ensure you receive appropriate medical attention. This service is to help avoid unnecessary or wasteful medical costs and is required for inpatient (hospital) admissions (within 24-48 hours of admission), outpatient surgeries, MRI, CAT Scans, PET Scans, nuclear imaging or transplants.
  • Do you have to meet any Deductibles or pay Co-pays: A co-pay or yearly deductible may have to be met in order to access certain benefits. On PPO plans, the in-network co-pays or deductibles for will be lower than your out-of-network co-pays or deductibles.
  • Are there any Exclusions and Limitations: While Benefit Summaries are great tools, they only provide a summary and may not include all the Exclusions and Limitations and other details you need to know to use your plan. Certain procedures may be specifically excluded (like cosmetic dentistry), or limited to a few times a year. Which brings us to Tip #2.

Tip # 2 Follow your Certificate of Insurance
After you enroll, BEST Life sends a Certificate of Insurance along with your ID card. This document explains how your BEST Life plan works, as well as what is covered and what is not covered.

The easiest way to read your Certificate of Insurance is to first read the sections that talk about preventive care. Then read the sections that talk about other treatment you may likely get. Always make sure to review the Exclusions and Limitations. This lets you know what treatments are not covered or how many times you may get a specific treatment.

Bring a copy of your Certificate of Insurance with you to your next appointment. That way you can refer to it when your healthcare provider suggests a treatment plan.

For Medical Plan Members Only: With the new Healthcare Reform, all BEST Life health plans have been updated with an Amendment. This Amendment explains what has changed due to Healthcare Reform. Make sure you read this, too! It explains how your health plan has changed.

Tip #3 Use a network provider
Using a network provider can really help you save on your out-of-pocket costs. Many BEST Life PPO plans provide more coverage if you go to an in-network provider. In addition, healthcare providers contracted with a BEST Life PPO network have agreed to provide services at a discounted rate. This can translate to a savings of 15% to 35% or more of what would normally be charged (depending on the plan, procedure and the area in which you live in).

Even if you are on a dental indemnity plan, it is worth looking into which PPO networks have a provider location near you. To find a network provider, look for the primary PPO network on your ID card. All BEST Life dental plans include additional access to DenteMax.

All our BEST Life health plans include access to a primary PPO network and the PHCS Healthy Directions for when you are traveling. To locate a network provider, click on the Provider Look-up link on the BEST Life website. You will need your ID card to verify your primary PPO network.

In Part 2, look for tips on why you should not use an emergency room for a cough, and useful health tools.

New Benefits Added to BEST Life Dental Plans

Last November, new benefits were added to BEST Life’s Dental PPO and IndemnityPlus plans.  These benefits offer you more choices when you need dental work.

In addition, we are in the process of making these benefits available to employer groups who renew with us beginning with December 1st, 2010 renewals.  So, if your group has not renewed yet, stay tuned!  These new benefits are coming.

DentistWhich one is right for you? Your dentist will recommend the best choice based on your oral health.

Posterior Composites: Posterior composites are temporary white resin (plastic) fillings that are placed on the back teeth and can be used in place of silver amalgams (silver metal fillings).

Posterior composites are popular because they provide a natural look to smiles.  However, if a large area of the tooth is decayed or used for heavy chewing, your dentist may recommend another material or type of restoration.  White fillings may last as long as amalgams.

This benefit is covered under Basic Services.

 Dental Implants: A dental implant is a natural-looking artificial tooth that is connected to your jawbone with an anchor and a post.  Used to replace a missing tooth or teeth, or to prevent jawbone loss, dental implants can be used in place of a bridge or denture.

Dental Implant Model without Crown

Dental implant model without crown

Dental implants can be thought of as a permanent, stable denture that you do not remove.  They stay in your mouth and even require the same dental care as natural teeth.

Because dental implants require the jawbone to grow around the anchor that holds the implant in place, dentists may recommend this type of restoration to patients who have stable bone structure.

Oral surgery may be required and the entire procedure can take anywhere from three months to six months or longer, depending on your oral health and the healing process necessary for preparing the jaw for implantation.

This benefit is covered under Major Services and in lieu of a bridge.

Intravenous Sedation: Intravenous sedation or IV sedation is a type of sedation that is injected into the bloodstream.  This is an alternative to general anesthesia, which is a sedation that is inhaled. Both forms of sedation help reduce anxiety while undergoing oral surgery. 

Intravenous sedation and general anesthesia are not pain killers, and your dentist may use a local anesthetic to numb your mouth before operating. 

Dentists must follow specific guidelines to ensure that patients are sedated safely.  If you have any questions or concerns about their use, please ask your dentist.

Covered as an alternative to general anesthesia, for partial and complete bony impacted extractions only.

Limited oral exam: Dentists perform limited oral examinations to diagnose the cause of a toothache, sore gums, or any other discomfort brought to his or her attention. 

Because limited oral exams focus on just one major concern, these are documented separately from a complete oral examination that is provided at a routine office visit. 

Covered as a basic service, once per 6 months.

Periodontal exam: A follow-up exam that ensures periodontal treatment is healing appropriately.  Included with periodontics, not in addition to a routine oral exam.

Dental benefits may vary by plan. For complete details, please refer to your BEST Life Certificate of Insurance for benefits and exclusions and limitations.  For questions, contact BEST Life’s Customer Service at 1-800-433-0088 or via email at cs@bestlife.com.

Sources: American Dental Association (ADA). “Oral Health Topics: Implants”, www.ada.org/2966.aspz?currentTab=1, October 29, 2010. American Dental Association (ADA). “Oral Health Topics: Amalgam (Dental Filling Options)”, www.ada.org/3094.aspx?currentTab=1, October 29, 2010. American Dental Association (ADA). “Oral Health Topics: Anesthesia & Sedation”, www.ada.org/2946.aspx?currentTab=1, January 19, 2011. ToothIQ. “Limited Oral Exam”, http://toothiq.com/dental-procedures-services-treatment-codes/dental-exam-limited-oral-problem-focused.html.

Important Changes Effective 10/1/10

This posting is to keep you up-to-date on the implementation of health care reform required by the Patient Protection and Affordable Care Act (“PPACA”) and other changes that went into effect as of October 1, 2010.

New dental and vision dependent age limits.  As of October 1, 2010, married and unmarried dependents up to age 26 are now eligible for coverage, regardless of student status.  Any groups starting with October 1, 2010 effective dates may include these dependents at open enrollment.

The new dependent age limits will apply to in-force groups upon renewal, or can be applied upon the employer’s request.  Employees will be given a 30-day period to enroll their dependents.  In-force groups have been notified of this option at the beginning of this month, and a copy of the notice has been sent to their brokers.

Updated medical benefit summaries now available. Grandfathered and Non-Grandfathered benefit summaries are now available upon request.  To request one, please contact Customer Service by calling 800.433.008 or via email at cs@bestlife.com.

Oral Piercing: Not as Safe as You Think

Piercing, like tattooing, is just one of today’s popular forms of “body art” and self-expression. Piercing may seem daring, cool and totally safe because some celebrities use piercing to flaunt their particular style or attitude. But piercing the tongue, lips, cheeks or uvula (the tiny tissue that hangs at the back of the throat) is not as safe as some would have you believe. That’s because the mouth’s moist environment—home to huge amounts of breeding bacteria—is an ideal place for infection.
An oral piercing can interfere with speech, chewing or swallowing. That may seem like a mere inconvenience until you consider that it may also cause:

  1. Excessive drooling (something you won’t see in hip fashion magazines!)
  2. Infection, pain and swelling
  3. Chipped or cracked teeth
  4. Injuries to the gums
  5. Damage to fillings
  6. Increased saliva flow
  7. Hypersensitivity to metals
  8. Scar tissue
  9. Nerve damage

These harmful effects can happen during the piercing, soon after, or even long after the procedure.

An infection can quickly become life threatening if it’s not treated promptly. For example, oral piercing carries a potential risk of endocarditis, an inflammation of the heart valves or tissues. Bacteria can enter the bloodstream through the piercing site in the mouth and travel to the heart, where it can colonize on heart abnormalities. This is a risk for people with heart conditions and, in the worst of cases, results in death.

After a piercing the tongue may swell. There have been reports of swelling serious enough to block the airway. And it’s very possible to puncture a nerve during a tongue piercing. If this happens, you may experience a  “numb” tongue—nerve damage that is sometimes temporary, but can be permanent. The injured nerve may affect your sense of taste, or how you move your mouth. And damage to the tongue’s blood vessels can cause serious blood loss.

In addition, piercing jewelry can sometimes cause allergic responses to the pierced site. The jewelry can even get in the way of dental care by blocking x-rays.

Don’t pierce on a whim. The piercing will be an added responsibility to your life, requiring constant attention and upkeep. Talk to your dentist for more information.

For more tips or fun activity sheets for children, visit http://www.ada.org/prof/events/featured/ncdhm.asp.

© 2010 American Dental Association (ADA). All rights reserved.
Reprinted with permission from the ADA. On the Web at: http://www.ada.org/prof/events/featured/ncdhm.asp.

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