Share of Cost – Maintaining Good Oral Health with Dental Insurance and Preventive Care

Monday, Mar. 11th 2024 10:00 AM

Hello and welcome! If you’re reading this, chances are you’re either interested in dental insurance or curious about what it entails. Dental insurance is a type of insurance that covers dental care expenses, including preventive care, restorative treatments, and emergency services. It’s an essential investment in oral health and financial well-being, as dental procedures can be costly without insurance coverage. At shareofcost.com, we offer a variety of dental insurance plans that cater to your specific needs. Our comprehensive and affordable plans ensure you receive the best dental care without breaking the bank. To learn more about our dental insurance plans, please call us at 310-534-3444.

Share of Cost – Preventive Dental Care and Insurance 

Did you know dental insurance can help you save money even if you have healthy teeth and gums? Many dental insurance plans offer preventive dental services, such as bi-annual checkups, cleanings, and X-rays, at little to no cost. Even low-cost plans like HMOs can cost just $8 to $20 a month for individuals, and the savings you can reap on preventive care alone can run upwards of a couple hundred dollars a year. Dental insurance is not just for those with dental problems but also a valuable investment in your oral health and financial well-being. 

The Importance of Having Dental Insurance

Having dental insurance is incredibly important for several reasons. Firstly, dental insurance can help you save money on dental care expenses, such as preventive care, restorative treatments, and emergency services. Dental insurance is especially crucial for those on a tight budget or who want to avoid paying out-of-pocket for costly dental procedures. Dental insurance plans can help cover dental care costs, making it more affordable for everyone.

Secondly, dental insurance can help with a “share of cost” obligation. A share of cost is a type of deductible that some individuals may have to meet before their Medicaid coverage kicks in. Suppose an individual has certain medical expenses in a given month. In that case, the individual may have to pay a certain out-of-pocket amount before Medicaid covers the remaining costs. The monthly cost of dental insurance can count towards this share of cost, meaning having dental insurance can help you meet a spend-down obligation more easily.

Finally, dental insurance can promote good oral health, essential for overall health and well-being. Regular dental checkups and cleanings are crucial for maintaining healthy teeth and gums, and dental insurance plans often cover these preventive services at little to no cost. Individuals with dental insurance are more likely to receive regular dental care, which can ultimately help prevent more serious dental problems.

Having dental insurance is essential for saving money on dental care expenses, meeting a share of cost obligation, and promoting good oral health. At shareofcost.com, we offer a variety of dental insurance plans that cater to your specific needs and budget. Our plans provide affordable coverage, ensuring you receive the best dental care without breaking the bank.

Do Not Overstate the Significance of Preventive Dental Care.

Preventive dental care is crucial to maintaining good oral health and overall well-being. It involves regular visits to the dentist, routine cleanings, and other preventive measures that can help prevent dental problems before they become more severe. The importance of preventive dental care should not be overstated, as it can save you both time and money in the long run.

One example of the importance of preventive dental care can be seen in a recent study conducted by the American Dental Association. The study found that individuals who received preventive dental care, such as regular cleanings and checkups, were less likely to require more extensive and expensive dental treatments in the future. This is because preventive care can help catch dental problems before they become more severe, allowing for earlier intervention and treatment.

Another example of the importance of preventive dental care can be seen in a personal story. A friend of mine neglected to visit the dentist for several years, thinking she would be fine if she brushed and flossed regularly. However, when she finally did go to the dentist, she found out that she had several cavities and needed a root canal. Regular preventive care could have easily prevented her from painful and expensive dental procedures.

In addition to helping prevent dental problems, preventive dental care can promote better overall health. Poor dental hygiene has been linked to a variety of health problems, including heart disease, diabetes, and even certain types of cancer. Taking care of your teeth and gums can help reduce your risk of these and other health issues.

The importance of preventive dental care cannot be overstated. Regular visits to the dentist, routine cleanings, and other preventive measures can help prevent dental problems before they become more severe, saving you both time and money in the long run. Caring for your teeth and gums can promote better overall health and well-being.

Why Bi-Annual Dental Checkups are Essential for Your Oral Health

Bi-annual dental checkups are an essential part of maintaining good oral health. During these checkups, the dentist thoroughly examines your teeth and gums, looking for any signs of decay, gum disease, or other dental problems. By detecting these issues early on, the dentist can prevent them from becoming more severe and requiring more extensive treatment. Regular bi-annual checkups also allow the dentist to provide preventive treatments such as cleanings and fluoride treatments, which can help keep your teeth and gums healthy and strong. By staying on top of your dental health with bi-annual checkups, you can prevent dental problems from developing and ensure that your smile stays healthy and beautiful for years to come.

The Importance of X-Rays in Dental Care: How They Help Dentists Diagnose and Treat Dental Problems

Dentists take X-rays to help diagnose dental problems that are not visible to the naked eye. X-rays allow dentists to see inside the teeth and gums, identifying issues such as cavities, abscesses, or impacted teeth. X-rays are also essential for monitoring the progress of dental treatments, such as braces or root canals. By taking X-rays, dentists can detect dental problems early on, preventing more severe issues from developing. Overall, X-rays are essential in dental care, helping dentists provide accurate diagnoses and effective treatments.

The Importance of Basic Dental Cleanings

Basic dental cleanings are an essential part of preventive dental care. Regular cleanings can help remove plaque and tartar build-up, which can lead to tooth decay and gum disease if left untreated. These cleanings also allow your dentist to examine your teeth and gums for signs of any potential issues. By scheduling regular dental cleanings, you can maintain good oral health and catch any problems before they become more severe and require more costly and invasive treatments. Basic dental cleanings are integral to keeping your teeth and gums healthy for a lifetime.

Cost of Dental Insurance with Regarding Meeting a Spend Down.

The cost of dental insurance can play an essential role in helping individuals spend down their income to reduce or eliminate their Medi-Cal share of cost. For those eligible for Medi-Cal, the program requires enrollees to pay a share of their medical expenses based on their income. Once an individual has met their share of cost for the month, Medi-Cal will cover the remaining costs. 

By purchasing dental insurance, individuals can use the cost of their dental insurance premiums to help reduce their income and lower their Medi-Cal share of cost. This can be especially helpful for those requiring frequent dental services, as the out-of-pocket costs can quickly increase. Additionally, dental insurance can provide more comprehensive coverage for dental services than Medi-Cal, allowing individuals to receive care without worrying about cost. By carefully considering the cost of dental insurance and comparing different plan options, individuals can find a plan that fits their budget and helps them meet their dental needs while reducing their share of cost.

Cost of Dental Insurance Between Different Plan Types Regarding  

Regarding dental insurance, the cost can vary significantly between different plan types. Understanding the differences between these plans is essential to make an informed decision about which one is right for you.

PPO, HMO, and indemnity plans are the most common dental insurance plans. PPO plans typically offer more flexibility and freedom when choosing a dentist, but they can be more expensive than HMO plans. HMO plans, on the other hand, usually have lower monthly premiums but may restrict you to a network of dentists. Indemnity plans allow you to see any dentist you choose but can be the most expensive option.

In addition to these plan types, there are also varying levels of coverage. Some plans may only cover primary preventive care, while others may cover more extensive treatments like orthodontics or oral surgery. Plans that cover more services will generally come with a higher monthly premium.

When considering the cost of dental insurance, it’s essential to look beyond just the monthly premium. It would help if you also considered each plan’s deductible, co-payments, and annual maximums. The deductible is the amount you must pay out of pocket before the insurance kicks in. Co-payments are the amount you pay for each visit or service; the annual maximum is the most the insurance will pay out in a given year.

Overall, the cost of dental insurance can vary significantly between different plan types and levels of coverage. It’s essential to carefully consider your options and choose a plan that provides the coverage you need at a price you can afford. By doing so, you can ensure that you receive the best dental care without breaking the bank.

Understand an HMO Dental Insurance Plan

An HMO dental insurance plan is a type of dental coverage that offers a network of dentists and dental facilities to its members. With an HMO dental insurance plan, you must choose a primary care dentist from within the network. You must receive all dental services from that provider or obtain a referral from them to receive services from another provider within the network. 

There are several benefits to choosing an HMO dental insurance plan. Firstly, HMO dental plans are typically more affordable than other dental insurance plans, making them an excellent option for individuals on a tight budget. The cost of an HMO dental plan is usually lower. It limits the provider network, and members must choose a primary care dentist from within that network.

Secondly, HMO dental insurance plans often cover preventive care services, such as cleanings, X-rays, and checkups, at little to no cost to the member. Preventive care is essential for maintaining good oral health and can help prevent more severe dental problems in the future. By covering these services, HMO dental plans encourage members to receive regular dental care, which can ultimately save them money in the long run by avoiding more costly dental procedures.

Thirdly, HMO dental plans have a simple process for receiving dental care. Members only need to choose a primary care dentist; that provider will coordinate all dental services, including referrals to specialists if necessary. This means that members don’t have to spend time searching for a provider, as all the necessary resources are provided through the network.

Finally, HMO dental plans often have a low or no deductible, meaning members can receive dental care without meeting a specific out-of-pocket expense first. This can be especially beneficial for those needing frequent dental care or on a tight budget.

In summary, HMO dental insurance plans offer a network of dental providers and are typically more affordable than other dental insurance plans. They often cover preventive services at little to no cost, have a simple process for receiving dental care, and may have a low or no deductible. By choosing an HMO dental insurance plan, you can receive the dental care you need while saving money on dental expenses.

Understand a PPO Dental Insurance Plan

A PPO dental insurance plan is a type of dental insurance that offers a network of dentists who have agreed to provide services to plan members at UCR rates. Unlike other dental insurance plans, PPO plans give you the freedom to choose your dentist, whether in-network or out-of-network. If you are considering dental insurance, here are some benefits of selecting a PPO plan:

1. Wide Network of Dentists: PPO plans have an extensive network of dentists, giving you a greater choice of providers. You can choose a dentist close to your home or workplace, making getting the dental care you need more convenient.

2. Flexibility: With a PPO plan, you can see any dentist you choose, whether in-network or out-of-network. If you choose an out-of-network dentist, you may have to pay a higher percentage of the cost, but you will still receive some coverage.

3. No Referrals Required: PPO plans do not require you to get a referral from your primary care dentist before seeing a specialist. This means you can go directly to a specialist for the necessary care without going through additional steps.

4. Preventive Care Coverage: PPO plans often cover preventive care services like cleanings and checkups at little or no cost to you. This helps you maintain good oral health and catch potential problems early on.

For example, let’s say you need a root canal. With a PPO plan, you can choose your dentist and receive coverage for the procedure. If you choose an in-network dentist, you will likely be within the company UCR rates on the procedure, saving you money. If you choose an out-of-network dentist, you still receive coverage but may have to pay a higher percentage of the cost and may have UCR fees. 

In conclusion, a PPO dental insurance plan offers a vast network of dentists, flexibility, cost savings, no referral requirements, and coverage for preventive care services. These benefits make PPO plans an attractive option for those looking to save money on dental care expenses while still receiving quality care from a dentist of their choice.

The Benefits of Investing in Dental Insurance: Save Money, Promote Oral Health, and Meet Share-of-Cost Obligations with ShareofCost.com

In conclusion, investing in dental insurance is a wise decision to help you save money on dental care expenses, meet a share of cost obligation, and promote good oral health. Regular preventive dental care is essential to maintaining good oral health and overall well-being, and dental insurance can make it more affordable for everyone. 

At shareofcost.com, we offer a variety of dental insurance plans that cater to your specific needs and budget. Our plans provide affordable coverage, ensuring you receive the best dental care without breaking the bank. We can also help you meet a spend-down requirement by counting the monthly cost of dental insurance towards it. Don’t wait until dental problems become more severe and costly – invest in dental insurance today and take the first step towards a healthier smile!

If you have any questions or would like to learn more about our dental insurance plans, please don’t hesitate to contact us. Our friendly and knowledgeable representatives can assist you from 8 am to 4 pm Monday through Friday. Call our office at 310-534-3444 and let us help you find the best dental insurance plan that caters to your specific needs and budget. 

We understand that dental care can be expensive, and we are committed to providing you with affordable and comprehensive coverage that ensures you receive the best dental care without breaking the bank. Please don’t wait any longer; call us today and take the first step towards better oral health and financial well-being.

Posted on Monday, Mar. 11th 2024 10:00 AM | by Share of Cost | in Dental Insurance, Medi-Cal, Medicaid, Medicare, Share of Cost, Social Security | Comments Off on Share of Cost – Maintaining Good Oral Health with Dental Insurance and Preventive Care

Share of Cost – What can I do if I need help with my share of cost?

Monday, Mar. 4th 2024 10:00 AM

Do you need help finding dental insurance for your spend-down needs? At Shareofcost.com, we can help you find the right dental insurance plan that fits your requirements. Our team of experts can guide you through the process, compare different plans, and help you make an informed decision. With our assistance, you can get the dental care you need without facing financial hardships. Contact us today at 310-534-3444 to learn how we can help you with your dental insurance needs.

A Guide To Learn About Share of Cost 

Hello, this is a guide to learn about the Share of Cost and how to deal with related issues. Patients must pay a certain amount for medical expenses before Medi-Cal can start covering the costs. It is a deductible that needs to be met before insurance coverage becomes effective. The amount of the Share of Cost varies based on the patient’s income and other factors. It can be a significant financial burden for those who struggle to make ends meet. Therefore, it is crucial to comprehend how the Share of Cost works and take necessary steps to address any issues.

Importance of addressing Share of Cost issues

As we mentioned earlier, the Share of Cost is a significant financial burden for those struggling to make ends meet. Addressing any issues related to the Share of Cost is crucial to ensure patients can access the medical care they need without facing financial hardships. 

If you don’t take the necessary steps to address Share of Cost issues, you may pay more than you should, or even worse, you may be denied access to the medical care you need. By questioning your Share of Cost and understanding how it works, you can ensure you pay what you should and get the medical care you need.

It is also important to note that the Share of Cost is based on a patient’s income and other factors, which can change over time. By staying informed and up-to-date about your Share of Cost, you can ensure that you are prepared for any changes and can take the necessary steps to address any issues.

Addressing Share of Cost issues is essential to ensure patients can access the medical care they need without facing financial hardships. If you have any questions or concerns about your Share of Cost, don’t hesitate to contact your Medi-Cal case worker, request a fair hearing, or contact the Center for Healthcare Rights Hotline for assistance.

Steps to take if you are eligible for free Medi-Cal or your Share of Cost is too high.

If you are eligible for free Medi-Cal or your Share of Cost is too high, there are several steps you can take to address the issue. To take the first step, you should contact your Medi-Cal case worker and write to them inquiring about the reason behind your Share of Cost or why your bill cannot be applied towards meeting your Share of Cost. It would help if you also asked what law Medi-Cal based its decision on.

If you are unsatisfied with the explanation, you can request a fair hearing. A fair hearing allows you to question Medi-Cal’s decision about your bill. You can call 1-800-952-5253 to get a fair hearing. It is important to note that calls to this number are free.

Another option is to speak to your county worker’s supervisor. If your problem is fixed, you can always cancel the fair hearing.

Call the Center of Healthcare Rights Hotline at 1-213-383-4519 if you have questions or concerns. They are available to help you and provide further assistance.

It is essential to take these steps to ensure you can access the medical care you need without facing financial hardships. By questioning your Share of Cost and understanding how it works, you can ensure you pay what you should and get the medical care you need.

Communicate with your Medi-Cal case worker.

Communicating with your Medi-Cal case worker can be crucial in ensuring you receive the best possible healthcare services. Your caseworker can assist you with various issues related to your Medi-Cal benefits, including eligibility, enrollment, and the application process. Additionally, they can provide helpful information about the multiple types of healthcare services available to you, such as preventative care, mental health services, and emergency care. If you have any questions or concerns about your Medi-Cal benefits, don’t hesitate to contact your caseworker for assistance. They are there to help ensure that you receive the care you need to stay healthy.

Tips on Communicate with your Medi-Cal Case Worker.

1) Request an explanation in writing: When you request someone to explain in writing, they need to put their thoughts into words and provide a clear and concise explanation in a written format. This approach can be beneficial for several reasons. Firstly, it helps maintain a record of the explanation for future reference or sharing with others who were not present when it was given. Secondly, requesting an explanation in writing ensures clarity and understanding, allowing the recipient to read and re-read the written explanation to fully comprehend the information being conveyed. Lastly, if you need a detailed and clear explanation, requesting it in writing is the best way to go.

2) Inquire why one cannot use a bill to cover the expenses: Keeping track of your medical bills and payments is essential, especially when you are enrolled in a Medi-Cal program with a share of cost. Sometimes, despite paying your bills, you may see that they did not go towards your share of the cost. In such situations, you must communicate with your Medi-Cal case worker and ask them about the issue. Your caseworker can help you understand why the bill did not count towards your share of the cost and what steps you can take to resolve the issue. They can also inform you about your current share of cost status and how much more you need to pay to meet your share of cost. So, contact your Medi-Cal case worker with any doubts or concerns about your medical bills and payments.

3) Ask what law Medi-Cal based its decision: If you ever receive a Medi-Cal decision that you are not satisfied with, it is essential to ask your Medi-Cal case worker what law or regulations they based their decision on. Doing so can help you understand the legal basis for the decision and identify any potential errors or misinterpretations. It can also help you prepare a more effective appeal if you decide to challenge the decision. By asking for the specific law or regulation, you can ensure the decision was based on accurate and up-to-date legal information. So, if you have any questions or concerns about a Medi-Cal decision, don’t hesitate to ask your case worker about the legal basis for the decision.

4) Inquire about the status of your application or renewal: If you have applied for Medi-Cal or need to renew your benefits, keeping track of the application status is essential. You can inquire about your application or renewal status by contacting your local county human services agency or calling the Medi-Cal hotline. Ensure your case number or other identifying information is readily available when contacting them. They can update you on your application or renewal status, let you know if any additional information is needed, and guide you through the process if you encounter any issues. It is always better to follow up and ensure that your application or renewal is processed correctly and promptly to avoid any gaps in coverage.

5) If needed, request assistance in finding a healthcare provider: Your Medi-Cal case worker can provide you with a list of healthcare providers in your area that accept Medi-Cal. You can also visit the Medi-Cal website or call their customer service number to obtain a list of healthcare providers. Additionally, you can contact community health clinics or non-profit organizations that assist in finding healthcare providers. Finding a healthcare provider that meets your needs and ensures you receive the best possible care is essential, so don’t hesitate to ask for help if you need it.

6) Report changes in your income or living situation: It is essential to report any changes in your income or living situation to the relevant authorities, especially regarding share of cost. The share of cost is the amount of money a person has to pay before Medicaid starts paying for their medical expenses. If you fail to report any changes, you may be billed for medical expenses you thought were covered. For instance, if you get a raise, your share of the cost may increase, and you will need to pay more out of pocket. Similarly, if you move to a different state, your cost share may change due to differences in cost of living and state Medicaid policies. Therefore, it is crucial to report any changes immediately to ensure you are aware of medical bills you cannot afford to pay.

7) Request an appeal or fair hearing if you disagree with a decision: 

If you disagree with a decision regarding your Share of Cost, you can appeal or request a fair hearing. To request an appeal or fair hearing, contact your Medi-Cal caseworker and request a Notice of Action. The notice will contain:

  • The decision you are appealing.
  • The reason for the decision.
  • Information on how to request an appeal or fair hearing.

You can also call the Medi-Cal Managed Care Ombudsman’s toll-free number for assistance in filing an appeal or fair hearing. It’s essential to act quickly on an appeal as there is a time limit for filing an appeal or fair hearing. Once you file an appeal or fair hearing, you will be notified of the date and time of your hearing, where you can present evidence and argue your case.

8) Inquire about additional benefits or programs you may be eligible for: It is always a good idea to inquire about additional benefits or programs you may qualify for regarding healthcare. Many people may not be aware of the various programs or services they can access that could help them reduce medical expenses or provide additional support. By inquiring about these options, you can potentially find programs that can help you save money, get additional care, or access resources that can make managing your health more accessible. Your Medi-Cal case worker can provide information about available programs and eligibility requirements, so don’t hesitate to ask and explore your options.

9) Ask for assistance with transportation to medical appointments: If you are struggling to cover the costs of transportation to medical appointments due to your Share of Cost, resources are available to help. One option is to contact your Medi-Cal case worker and ask for assistance. Your case worker can provide information about transportation programs that may be available to you. Additionally, many community organizations offer transportation services to medical appointments for individuals with low incomes and disabilities. You can also check with your healthcare provider to see if they provide transportation services or if you can partner with them. Feel free to ask for transportation assistance to ensure you can access the medical care you need without facing financial hardships.

10) Request language or disability accommodations for appointments or services:   If you require language or disability accommodations for appointments or services, it is essential to communicate your needs to your healthcare provider or service provider. Many healthcare providers and service providers offer accommodations such as interpretation services, written materials in other languages, and physical or communication aids for individuals with disabilities. By requesting these accommodations, you can ensure equal access to healthcare and services and receive the care and support you need. Don’t hesitate to ask your provider or service provider about available accommodations, as they help you and ensure that you receive the best possible care.

11) Report any suspected fraud or abuse in the Medi-Cal program: Reporting any suspected fraud or abuse in the Medi-Cal program is essential to ensure the program’s integrity and protect public funds. Fraud or abuse in the Medi-Cal program can take many forms, including billing for services not provided, providing unnecessary services, or falsifying medical records. Such actions can result in significant financial losses for the program and harm patients by providing them with unnecessary or harmful treatments. By reporting any suspected fraud or abuse, you can help ensure that resources are used efficiently and effectively and that patients receive appropriate care. Additionally, reporting such incidents can help prevent future fraud or abuse, protecting both the program and the patients it serves.

12) Inquire about the process for resolving billing or claims issues:  If you have any billing or claims issues related to your Share of Cost, it is crucial to inquire about the process for resolving them. The first step is to contact your Medi-Cal case worker and ask for an explanation. You can request a fair hearing if you are unsatisfied with the answer or the unresolved issue. You can present your case during the hearing and ask questions to Medi-Cal representatives. You can contact the Center for Healthcare Rights Hotline for further assistance if the issue is unresolved. It is essential to take these steps to ensure you receive the medical care you need without facing financial hardships. 

Understanding Your Share of Cost and Advocating for Yourself: Steps to Take for Medi-Cal-Related Issues

When handling your Share of Cost, it’s essential to understand the process and take necessary steps to address any issues. As we previously discussed, patients must pay a certain amount for medical expenses before Medi-Cal can start covering the costs. This deductible can be a significant financial burden for those who struggle to make ends meet.

If you need help with your Share of Cost, there are several steps you can take to address the issue. First, contact your Medi-Cal case worker and inquire about the reason behind your Share of Cost or why your bill cannot be applied towards meeting your Share of Cost. If unsatisfied with the explanation, you can request a fair hearing to question Medi-Cal’s decision about your bill. You can also speak to your county worker’s supervisor. If your problem is fixed, you can always cancel the fair hearing.

It is essential to take these steps to ensure you can access the medical care you need without facing financial hardships. By questioning your Share of Cost and understanding how it works, you can ensure you pay what you should and get the medical care you need.

Advocating for yourself and seeking assistance when needed is crucial in ensuring you receive the best healthcare services. Your caseworker can assist you with various issues related to your Medi-Cal benefits, including eligibility, enrollment, and the application process. Additionally, they can provide helpful information about the multiple types of healthcare services available to you, such as preventative care, mental health services, and emergency care.

It’s essential to communicate with your Medi-Cal case worker and ask questions when you need help. Request an explanation in writing to ensure clarity and understanding. If you have any concerns or questions about your Medi-Cal benefits, don’t hesitate to contact your caseworker for assistance. They are there to help ensure that you receive the care you need to stay healthy.

Let me share a story to emphasize the importance of advocating for yourself. A few years ago, my friend’s mother was diagnosed with a chronic illness. Her Share of Cost was high, and she was struggling to afford the medical care she needed. They reached out to her Medi-Cal case worker but didn’t receive a satisfactory explanation. They decided to request a fair hearing, and the decision was overturned. She finally received the medical care she needed without facing financial hardships.

In conclusion, taking action and advocating for yourself is essential when dealing with Share of Cost and Medi-Cal-related issues. By following the steps we discussed and seeking assistance when needed, you can ensure that you receive the best possible healthcare services and access the care you need to stay healthy.

Thank you for considering Shareofcost.com for your dental insurance needs. We are always here to assist you, so please don’t hesitate to give us a call at 310-534-3444. Have a great day!

Posted on Monday, Mar. 4th 2024 10:00 AM | by Share of Cost | in Dental Insurance, Medi-Cal, Medicaid, Medicare, Share of Cost, Social Security | Comments Off on Share of Cost – What can I do if I need help with my share of cost?

Certifying Share of Cost Benefits and Coverage

Thursday, Oct. 13th 2011 6:37 AM

Subscribers are not eligible to receive Medi-Cal benefits until their monthly Share of Cost dollar amount has been certified online. Certifying SOC means that the Medi-Cal eligibility verification system shows the subscriber has paid or become obligated for the entire monthly dollar SOC amount owed. Claims submitted for services rendered to a subscriber whose SOC is not certified through the Medi-Cal eligibility verification system will be denied. Exception:    Share of Cost is certified differently for Long Term Care (LTC) subscribers with specific aid codes. To avoid duplicate billing, Hospice providers must indicate the SOC on the UB-04 claim when billing for hospice room and board (revenue code 658) if the SOC was not already met on a Payment Request for Long Term Care (25-1) claim.

Posted on Thursday, Oct. 13th 2011 6:37 AM | by Share of Cost | in Social Security | Comments Off on Certifying Share of Cost Benefits and Coverage

Reviewing the Multiflex Dental Insurance Plan in California

Sunday, May. 1st 2011 6:24 AM

Reviewing the MultiFlex Dental Insurance Classic Plan Max 2000 Underwritten by Nationwide Life Insurance Company. This dental insurance plan offers individual and family dental benefits for members age 64 and younger. If you are 65 years of age or older please select another dental plan. A family membership covers the head of household including spouse (if not legally separated or divorced from you); unwed child from the moment of birth, until the child attains age 19; and unwed child who is a student may be covered until age 26 provided such child is a full-time student and more than 50% dependent on you for support and maintenance and proof of the child’s enrollment as a full-time student has been submitted.

The dental insurance plan offers you a free choice of dentists and you can change your dentist anytime by notifying the company. Your savings are in place when you visit your dentist so you just show up for your dental appointment and make your co-payment – what could be easier? You can enroll anytime you prefer… Just a reminder that your online request must be processed on or before the 5th of the month for coverage to be effective the same month. Please review the dental benefit co-payments below and see how easy it is for you or your entire family to enjoy these quality dental benefits

Posted on Sunday, May. 1st 2011 6:24 AM | by Share of Cost | in Share of Cost | Comments Off on Reviewing the Multiflex Dental Insurance Plan in California

Always Care California Dental Plan Limitations and Exclusions

Saturday, Apr. 30th 2011 6:22 AM

Applicant’s Statements and Agreements:  1. I understand that the effective date of the policy will be the date recorded in the Policy Schedule of Benefits by the Company.  2. I understand the policy I am applying for contains different Waiting Periods for certain benefits listed in the Policy Schedule of Benefits. This means that no benefits are payable during the listed Waiting Period. The Waiting Period begins on the effective date of coverage.  3. I understand that dependent children, if any, will be covered until the end of the month following their 19th birthday (24th if full-time students).  4. I understand that: (a) Starmount Life Insurance Company is not bound by any statement made by me, the applicant, or any associate/agent of Starmount Life Insurance Company unless written herein. (b) The associate/agent cannot change the provisions of the policy or waive any of its provisions either orally or in writing. (c) The policy together with this application, endorsements, benefit agreements and riders, if any, is the entire contract of insurance. (d) No change to the policy will be valid until approved by Our president and secretary, and noted in or attached to the policy.

5. I acknowledge receipt of, if applicable:Outline of Coverage.

Authorization to Obtain Information: I authorize the following to give information (defined below) to Starmount Life Insurance Company or any person or group acting on their part: any medical professional, any medical care institution, insurer, reinsurer, government agency, or employer. “Information” means facts of a medical nature in regard to my physical or mental condition, employment, or other insurance coverage. I understand that this information will be used by Starmount Life Insurance Company to determine eligibility for insurance and may be used to evaluate a claim for benefits during the time it is valid. I agree that this authorization is valid for 30 months from the date signed. I know that I have a right to receive a copy of this authorization upon request. I agree that a copy of this authorization is as valid as the original.

Please Note : California law prohibits an HIV test from being required, DISCLOSED or used by health insurance companies as a condition of obtaining health insurance cove rage .

I understand that the premium amount listed on this application represents the premium amount that either my employer will remit to Starmount Life Insurance Company on my behalf, or I will remit directly to them. I further understand that this amount, because of my employer’s billing/payroll practices, may differ from the amount being deducted from my paycheck or the premium amount quoted to me by my associate/agent. I also understand that if I am receiving any Medicaid benefits, the purchase of this coverage may not be necessary. If I am applying to replace existing coverage with this policy, I acknowledge that the policies may have different benefits and that I should make a comparison to personally determine which is best for me. I understand and agree that I am terminating my current policy and its benefits for the benefits provided in the Starmount Life Insurance Company Policy. I have read, or had read to me, the completed application, and I realize policy issuance is based upon statements and answers provided herein, and they are complete and true to the best of my knowledge and belief. I understand that any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

Posted on Saturday, Apr. 30th 2011 6:22 AM | by Share of Cost | in Share of Cost | Comments Off on Always Care California Dental Plan Limitations and Exclusions

AlwaysCare One Plus PPO Dental Value Plan in California

Friday, Apr. 29th 2011 6:21 AM

Reviewing the AlwaysCare One Plus PPO Dental Value Plan $1000 Max Benefit underwritten by Starmount Life Insurance Company for Adults (ages 19 to 64). This dental plan offers individual and family dental benefits. Family coverage includes the insured; the insured’s spouse; including and dependent, unmarried children to age 26. One-parent family coverage includes the insured and dependent, unmarried children to age 26. Newborn children are automatically covered from the moment of birth. The dental insurance plan offers you a free choice of network dentists.

Your savings are in place when you visit your dentist so you just show up for your dental appointment and make your co-payment – what could be easier? There is no waiting period for your preventive services to start. Please review the dental benefits paid by the insurance company below and see how easy it is for you or your entire family to enjoy these quality dental services. Just a reminder your mail-in application and payment must be received on or before the 20th of the month prior to the following month’s coverage effective date.

Posted on Friday, Apr. 29th 2011 6:21 AM | by Share of Cost | in Share of Cost | Comments Off on AlwaysCare One Plus PPO Dental Value Plan in California

Madison Nation Life Insurance Company Offers Dental Insurance With ShareOfCost.com

Thursday, Apr. 28th 2011 6:12 AM

Madison Nation Life Insurance Company Offers Dental Insurance With ShareOfCost.com — Consider the Indemnity Value Dental Insurance Plan $500 Maximum Benefit Underwritten by Madison National Life Insurance Company, Inc. This dental insurance plan offers dental benefits for individuals and families. A family membership covers the applicant, spouse, and your dependent children ages 25 or younger. The dental insurance plan offers your choice of dentist and you can change your dentist anytime by notifying the company. Your savings are in place when you visit your dentist so you just show up for your dental appointment and make your co-payment – what could be easier? Dental health care and orthodontic coverage is included for dependent children.

There is no waiting period for your preventive services to start. Please review the dental benefit co-payments below and see how easy it is for you or your entire family to enjoy these quality dental services. Just a reminder your online request must be processed on or before the 20th of the month prior to the following month’s coverage effective date.

Posted on Thursday, Apr. 28th 2011 6:12 AM | by Share of Cost | in Share of Cost | Comments Off on Madison Nation Life Insurance Company Offers Dental Insurance With ShareOfCost.com

Pacific Care Dental Plan, California Plan Limitations and Exclusion

Wednesday, Apr. 27th 2011 6:07 AM

The orthodontic benefit covers: consultation, all necessary appliances, banding, and monthly office visits for 24 months. Specific co-payment levels have also been set for start-up and retention services.  Orthodontic treatment must be provided by a Panel Orthodontist. A referral must be submitted by the assigned general dentist and approved by the Plan. Rates and coverage’s subject to change without notification.

LIMITATIONS AND EXCLUSION:

ARBITRATION: The Plan uses binding arbitration to resolve any and all disputes between the Plan and group or member, including, but not limited to, allegations against Plan of medical malpractice (that is an to whether any dental services rendered under the Plan were unnecessary or unauthorized or were improperly, negligently or incompetently rendered) and other disputes relating to the delivery of services under the Plan.

Plan, group and member each understand and expressly agree that by entering into the Plan services group subscriber agreement or enrolling in Plan and agreeing to be bound by the Plan subscriber agreement. Plan, group and member are each voluntarily giving up their constitutional right to have all such disputes decided in a court of law before a jury and instead are accepting the is of binding arbitration. Group and member further contracting provider including but not limited to claims against a Plan contracting provider for medical malpractice are not governed by the Plan subscriber agreement.

However Plan, group and member each expressly agree that the existence of any disputes between group or member and a Plan contracting provider, including but not limited to claims by groups or member against a Plan contracting provider for medical malpractice shall in no way affect the obligation to submit to binding arbitration all disputes between group or member and Plan.

LIMITATIONS: Dentures or partials once every five years and then only when dentures cannot be made serviceable; cleanings once every six months; relines not more than twice per year; full mouth x-rays once every two years; all family members must be assigned to the same dental office; orthodontic treatment must be provided by a member of the Plan Orthodontic Panel.

EXCLUSIONS: Oral surgery requiring the setting of fractures or dislocations; treatment of malignancies, cysts or neoplasms; dispensing of drugs; teeth extracted for orthodontic purposes; cosmetic dentistry; treatment of temporomandibular joint syndrome (tmj); treatment by a specialist.

DISCLOSURE: An application is a request for coverage which if approved by the Plan would then become the enrollment form and would be used to issue an identification card and a Disclosure Form. Upon acceptance of the application by the Plan, your benefits will become effective on the first of the next month. Detailed limitations and exclusions, coverage benefits, co-payments, as well as other services offered, are given in full in the Disclosure Form provided when coverage becomes effective. The Insurance Company always reserves the right to make the final determination with respect to all aspects of this Dental Program.

Posted on Wednesday, Apr. 27th 2011 6:07 AM | by Share of Cost | in Share of Cost | Comments Off on Pacific Care Dental Plan, California Plan Limitations and Exclusion

PacifiCare Dental Plan, United HealthCare Providers Plan Review

Tuesday, Apr. 26th 2011 6:03 AM

Regarding the PacifiCare Dental Insurance Plan (Region 1). This dental plan offers individual and family dental benefits. A family membership covers the head of household including spouse, your children 19 years of age or younger and your children up to age 23 if attending school full time. Your online request must be processed on or before the 20th of the month prior to the coverage effective date. This dental plan starts on the 1st of next month if you have enrolled by the 20th of this month. Be sure to leave yourself enough time to mail in your application.

There are no deductibles and no yearly limits on benefits, and there are no claim forms to fill out. Your savings are in place when you visit your dentist. You just show up for your dental appointment and make your co-payment – what could be easier? The dentists must meet the Plan’s standard of quality and service. All have agreed to provide dental care at the low co-payments available only to members. Review the dental benefit co-payments below and see how easy it is for you or your entire family to enjoy these quality dental services.

Posted on Tuesday, Apr. 26th 2011 6:03 AM | by Share of Cost | in Share of Cost | Comments Off on PacifiCare Dental Plan, United HealthCare Providers Plan Review

Dental Health Services Dental Plan Limitations and Exclusion

Monday, Apr. 25th 2011 6:01 AM

Dental Health Services Dental Plan Limitations and Exclusion: Summary of Dental exclusions: This is a very brief overview. Please refer to the evidence of coverage before purchasing this dental plan.  The following services are not covered by this dental plan:
A. Services that are not consistent with professionally recognized standards of practice.
B. Services related to implants or attachments to implants.
C. Cosmetic services, for appearance only, unless specifically listed.
D. Myofunctional therapy-procedures for training, treating or developing muscles in and around the jaw or mouth including T.M.J. and related diseases, except for occlusal guard.
E. Treatment for malignancies, neoplasms (tumors) and cysts as well as hereditary, congenital and/or developmental malformations.
F. Dispensing of drugs not normally supplied in a dental office.
G. Hospitalization charges, dental procedures or services rendered while patient is hospitalized.
H. Procedures, appliances or restorations (other than fillings) that are necessary for full mouth rehabilitation, to increase arch vertical dimension, or crown/bridgework requiring more than 10 crowns/pontics. Replacement or stabilization of tooth structure lost through attrition, abrasion or erosion.

Procedures performed by a prosthodontist.
I. Fixed bridges for patients under the age of sixteen, in the presence of nonsupportive periodontal tissue, when edentulous spaces are bilateral in the same arch, when replacement of more than four teeth in an arch, replacement of missing third molars, or when the prognosis is poor.
J. General anesthesia, including intravenous and inhalation sedation.
K. Dental procedures that cannot be performed in the dental office due to the general health and/or physical limitations of the member.
L. Expenses incurred for dental procedures initiated prior to member’s eligibility with Dental Health Services, or after termination of eligibility.
M. Services that are reimbursed by a third party (such as the medical portion of an insurance/health plan or any other third party indemnification).
N. Extractions of non-pathologic, asymptomatic teeth, including extractions and/or surgical procedures for orthodontic reasons.
O. Setting of a fracture or dislocation, surgical procedures related to cleft palate, micrognathia or macrognathia, and surgical grafting procedures.
P. Coordination of benefits with another prepaid managed care dental plan.
Q. Orthodontic treatment of a case in progress and/or retreatment of orthodontic cases.
R. Cephalometric x-rays, tracings, photographs and orthodontic study models.
S. Replacement of lost or broken orthodontic appliances.
T. Changes in orthodontic treatment necessitated by an accident of any kind.
U. Malocclusions so severe or mutilated which are not amenable to ideal orthodontic therapy.
V. Services not specifically covered on the Schedule of Covered Services and Copayments.

Dental limitations: Restrictions on benefits are applied to the following services
A. Treatment of dental emergencies is limited to treatment that will alleviate acute symptoms and does not cover definitive restorative treatment including, but not limited to root canal treatment and crowns.
B. Optional services: when the patient selects a plan of treatment that is considered optional or unnecessary by the attending dentist, the additional cost is the responsibility of the patient.
C. Routine teeth cleaning (prophylaxis) is limited to once every six months and full mouth x-rays are limited to one set every three years if needed.
D. Sealants are only a benefit for permanent posterior teeth of children under the age of eighteen.
E. Covered specialist referrals must be pre-approved by Dental Health Services.
F. Periodontal surgical procedures are limited to four quadrants every two years.
G. There are additional charges for precious/noble metals (gold).
H. Replacement will be made of any existing appliance (denture, etc.) only if it is unsatisfactory and cannot be made satisfactory. Prosthetic appliances will be replaced only after five years have elapsed from the time of delivery. Lost or stolen removable appliances are the responsibility of the enrollee.
I. Relines are limited to once per twelve months, per appliance.
J. Single unit inlays and crowns are a benefit as provided above only when the teeth cannot be adequately restored with other restorative materials.
K. The maximum benefit for all contracted specialty care, excluding orthodontics, is $1,000 per member, per contract year.

Orthodontic exclusions: The following services are not covered by this dental plan
A. Retreatment of orthodontic cases.
B. Treatment of a case in progress at inception of eligibility.
C. Surgical procedures (including extraction of teeth) incidental orthodontic treatment.
D. Surgical procedures related to cleft palate, micrognathia or macrognathia.
E. Treatment related to temporomandibular joint (TMJ) disturbances and/or hormonal imbalances.
F. Any dental procedure considered within the field of general dentistry,including but not limited to: myofunctional therapy; general anesthetics, including intravenous and inhalation sedation; dental services of any nature performed in a hospital.
G. Orthodontic treatment of a case in progress and/or retreatment of orthodontic cases
H. Cephalometric x-rays, tracings, photographs and orthodontic study models.
I. Replacement of lost or broken orthodontic appliances
J. Changes in treatment necessitated by an accident of any kind.
K. Services which are compensable under worker’s compensation or employer liability laws.
L. Malocclusions so severe or mutilated they are not amenable to ideal orthodontic therapy.

Orthodontic limitations: The following are subject to additional charges
A. Full banded treatments are based on a 24-month standard treatment plan. Additional treatment, or treatment that extends beyond that time may be subject to additional charges. If the contract between the enrollee and Dental Health Services is terminated, service is subject to a pro-rated fee based on current market value for the balance of orthodontic treatment. If the member should terminate coverage, they are no longer eligible for the enrollee orthodontic rate. Should the contract between Dental Health Services and the orthodontist terminate, any Dental Health Services members in treatment would not be subject to proration. Please call your Member Service Specialist at 800.63.SMILE for a referral to the nearest participating orthodontist.

Health plan benefits and coverage matrix: THIS MATRIX IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE BENEFITS AND IS A SUMMARY ONLY. THE EVIDENCE OF COVERAGE AND PLAN CONTRACT SHOULD BE CONSULTED FOR A DETAILED DESCRIPTION OF COVERAGE BENEFITS AND LIMITATIONS.

Deductibles: None
Lifetime maximums: None.
Professional services – exam & preventive services: No charge for most services.
Full mouth x-rays limited to every three years. Prophylaxis (cleanings) limited to every six months. Sealants limited to permanent teeth to age 18.
Professional services – restorative, crowns, endodontics and oral surgery services: Copayments for fillings, caps, root canals and extractions vary by procedure in the enclosed Schedule.
Professional services – periodontic services: Copayments for gum treatments vary by procedure in the enclosed Schedule. Surgical procedures are limited to four quads every two years.
Professional services – dentures and partial dentures: Copayments vary by procedure and appear in the enclosed Schedule. Replacements limited to every five years. Relines limited to every 12 months.
Professional services – specialty services: Copayments vary by procedure and appear in the enclosed Schedule of Covered Services and Copayments. There is a $1,000 maximum benefit per member, per contract year, excluding orthodontics. See Services when performed by a Dental Health Services specialist.
Outpatient office visits: $4 per visit
Hospitalization services: Not covered
Prescription drug coverage: Not covered
Emergency health services: Not covered
Ambulance services: Not covered
Durable medical equipment: Not covered
Mental health services: Not covered
Chemical dependency services: Not covered
Home health services: Not covered
This dental plan does not provide general anesthesia. Members requiring

Posted on Monday, Apr. 25th 2011 6:01 AM | by Share of Cost | in Share of Cost | Comments Off on Dental Health Services Dental Plan Limitations and Exclusion

Dental Health Services, Share of Cost California Dental Plan Review

Sunday, Apr. 24th 2011 6:59 AM

Dental Health Services, Share of Cost California Dental Plan Review — The Dental Health Services Super SmartSmile HMO Dental Plan. As the subscriber, you may enroll yourself, your spouse (unless legally separated) or your domestic partner, and/or unmarried dependent children who are under 19 years of age. Children 19 years of age and over are eligible if: The child is unmarried and a full-time student solely dependent upon subscriber for support, and is under 23 years of age; or the child is and continues to be both (1) incapable of self-sustaining employment by reason of a mental disability, including but not limited to, mental illness or a physical disability or a combination of those disabilities and (2) chiefly dependent upon the subscriber or member for support and maintenance. There are no deductibles and no yearly limits on most services, and there are no claim forms to fill out. Your savings are in place when you visit network dentist. You just show up for your dental appointment and make your copayment – what could be easier? The dentists must meet the Plan’s standard of quality and service.

All have agreed to provide dental care at a low cost available only to its members. There is no waiting period for your dental services to begin, many pre-existing dental conditions are covered and best of all, the dental plan services start the first day of next month if the company receives your mail-in application by the 10th of this month. Review the sample schedule below and see how easy it is for you or your entire family to enjoy these quality dental services.

Posted on Sunday, Apr. 24th 2011 6:59 AM | by Share of Cost | in Share of Cost | Comments Off on Dental Health Services, Share of Cost California Dental Plan Review

Liberty Dental Plans of California, Share of Cost Review

Saturday, Apr. 23rd 2011 6:53 AM

Here are some of the disclosures to consider when purchasing the Liberty Dental Plan of California: Liberty Dental Plan will activate your benefits on the first of next month if your mail-in application and payment is received in their office by the 20th of this month. Subject to cancellation as provided under this Program, enrollment of Eligible Members and Eligible Dependents* is for a minimum period of one year. Twelve Consecutive Months. All Members and Dependents must use a Dentist within the LIBERTY Dental Plan Network of California Dentists.

All services and benefits under our Dental Plans are covered only if provided by a contracted LIBERTY Dental Plan participating Primary Care Dentist or if referred to a Dental Specialist by LIBERTY Dental Plan. The only time you may receive care outside of the network is for true emergency dental services necessary when you are out-of-the area or cannot contact your Primary Care Dentist or LIBERTY Dental Plan. LIBERTY Dental Plan will reimburse you for true emergency dental treatment expenses up to a maximum of $75.00 per year, less applicable co-payments.

* Base metal is the benefit. Noble metal, high noble metal, titanium alloy and titanium, if used, will be charged to the member at the additional lab cost of the noble metal, high noble metal, titanium alloy or titanium. Exception: Implants and all services associated with implants are listed at the actual member co-payment amount. No additional fee is allowable for noble metal, high noble metal, titanium alloy or titanium for implants and procedures associated with implants.

Resin, porcelain and any resin to metal or porcelain to metal crowns and pontics are a benefit on anterior (teeth numbers 6-11, 22-27), first bicuspid (teeth numbers 5, 12, 21, and 28) and second bicuspid (teeth numbers 4, 13, 20, and 29) teeth only. The member will be charged the additional lab cost to add resin or porcelain to all molar (teeth numbers 1-3, 14-19, 30-32) crowns and pontics. Exception: Implants and all services associated with implants are listed at the actual member co-payment amount. No additional fee is allowable for resin or porcelain for procedures associated with implants.

The maximum amount chargeable to the member to upgrade to resin or porcelain on molar teeth (teeth number 1-3, 14-19, 30-32) and/or upgrade to noble metal, high noble metal, titanium alloy or titanium is $250.00

** Amalgam fillings are benefits on molar and bicuspid teeth (teeth numbers 1-5, 12-21, 28-32). If the member upgrades to a resin-based composite filling, they will pay the additional co-payment listed for these procedures (D2391-D2394).

*** Covered benefit only when in conjunction with covered oral surgery and pedodontic procedures when dispensed in a dental office by a practitioner acting within the scope of his/her licensure; and when warranted by documented conditions that local anesthetic is contraindicated. General anesthesia, as used for dental pain control, means the elimination of all sensations accompanied by a state of unconsciousness. Patient apprehension and/or nervousness are not of themselves sufficient justification for deep sedation/general anesthesia or intravenous conscious sedation/analgesia.

LIBERTY Dental Plan will arrange for you to receive services from a Contracted Dental Specialist if the necessary treatment is outside the scope of General Dentistry. Your General Dentist will initiate the referral process with LIBERTY Dental Plan. The proper referral process must be utilized for specialty services to be covered under your plan. X-rays for diagnostic purposes are benefits in the General Dentist’s office only.

Limitations

(1) Prophylaxis are covered once every six consecutive months. (2) Full Mouth X-rays are limited to once every 36 consecutive months. (3) Fluoride Treatments are covered once every 6 consecutive months, up to the 18th birth date. (4) Sealants are covered only on the first and second permanent molars and up to the 14th birth date. (5) Crowns, Jackets, Inlays and Onlays are benefits on the same tooth only once every five years, and consistent with professionally recognized standards of dental practice. (6) Replacement of existing Full and Partial Dentures are covered once per arch every 5 years, except when they cannot be made functional through reline or repairs. (7) Denture Relines are covered twice per year, and only when consistent with professionally recognized standards of dental practice. (8) Any routine dental services performed by a Primary Care Dentist or Specialist in an inpatient/outpatient hospital setting, under certain circumstances, will be considered for coverage.

Exclusions

(1) Any procedure not specifically listed as a Covered Benefit. (2) Replacement of lost or stolen prosthetics or appliances including crowns, bridges, partial dentures, full dentures, and orthodontic appliances. (3) Any treatment requested, or appliances made, which are either not necessary for maintaining or improving dental health, or are for cosmetic purposes unless otherwise covered as a benefit. (4) Procedures considered experimental, treatment involving implants or pharmacological regimens (See “Independent Medical Review” on page 5). (5) Oral surgery requiring the setting of bone fractures or bone dislocations. (6) Hospitalization. (7) Out-patient services. (8) Ambulance services. (9) Durable Medical Equipment. (10) Mental Health services. (11) Chemical Dependency services. (12) Home Health services. (13) General anesthesia, analgesia, intravenous/intramuscular sedation or the services of an anesthesiologist. (14) Treatment started before the member was eligible, or after the member was no longer eligible. (15) Procedures, appliances, or restorations to correct congenital, developmental or medically induced dental disorder, including but not limited to: myofunctional(e.g. speech therapy), myoskeletal, or temporomandibular joint dysfunctions (e.g. adjustments/corrections to the facial bones) unless otherwise covered as an orthodontic benefit. (16) Procedures which are determined not to be dentally necessary consistent with professionally recognized standards of dental practice. (17) Treatment of malignancies, cysts, or neoplasms. (18) Orthodontic treatment started prior to member’s effective date of coverage. (19) Appliances needed to increase vertical dimension or restore occlusion. (20) Any services performed outside of your assigned dental office, unless expressly authorized by Liberty Dental Plan, or unless as outlined and covered in “Emergency Dental Care” section.

Orthodontic Exclusions

(1) Lost, stolen or broken appliances. (2) Extractions for orthodontic purposes, (will not be applied if extraction is consistent with professionally recognized standards of dental practice or arises in the context of an emergency dental condition). (3) Temporomandibular joint syndrome (TMJ) surgical orthodontics. (4) Myofunctional therapy. (5) Treatment of cleft palate. (6) Treatment of micrognathia. (7) Treatment of macroglossia.

The California Department of Managed Health Care is responsible for regulating health care service plans. If you have a grievance against your Health Plan, you should first telephone your Health Plan at 1-888-703-6999 and use your Health Plan’s grievance process before contacting the Department. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your Health Plan, or a grievance that remained unresolved for more than 30 days, you may call the Department for assistance. You may also be eligible for Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a Health Plan related to the medical necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical services. The Department also has a toll-free telephone number (1-888-HMO-2219) and a TDD line (1-877-688-9891) for the hearing and speech impaired. The Department’s Internet web site http://www.hmohelp.ca.gov has complaint forms, IMR application forms and instructions online.

Posted on Saturday, Apr. 23rd 2011 6:53 AM | by Share of Cost | in Share of Cost | Comments Off on Liberty Dental Plans of California, Share of Cost Review

California Dental Network Plan Exclusions and Limitations

Thursday, Apr. 21st 2011 6:47 AM

California Dental Network Plan Exclusions and Limitations: An Enrollment Application is a request for coverage, which, if approved by California Dental Network, becomes the enrollment form used to issue an identification card and Combined Evidence of Coverage and Disclosure Form. All benefits, limitations and exclusions are stated in full in the Combined Evidence of Coverage and Disclosure Form which is provided when coverage becomes effective. Members will have 30 days from receipt of the Combined Evidence of Coverage and Disclosure Form to cancel their enrollment and receive a full refund of their premiums if they have not utilized the Plan. You may obtain a copy of the Combined Evidence of Coverage and Disclosure Form from their Corporate Office before you enroll.

Limitations (1) Prophylaxis (cleaning) is limited to once every six months. (2) Fluoride treatment is covered once every 12 months for Members up to age 14. (3) Bitewing x-rays are limited to one series of four films every 12 months. (4) Full mouth x-rays are limited to once every 24 months. (5) Sealants are covered for Members up to the age of 14 and are limited to permanent first and second molars. (6) Periodontal treatments (subgingival curettage and root planing) are limited to one treatment per quadrant in any 12-month period. (7) Fixed bridgework will be covered only when a partial cannot satisfactorily restore the case.(8) Replacement of partial dentures is limited to once every five years. (9) Full upper and/or lower dentures are not to exceed one each in any five-year period. (10) Denture relines are limited to one per arch in any 12-month period.

Exclusions (1) General anesthesia, analgesia (nitrous oxide), intravenous sedation, or the services of an anesthesiologist. (2) Treatment of fractures or dislocations; congenital malformations; malignancies, cysts, or neoplasms; or Temporomandibular Joint Syndrome (TMJ). (3) Extractions or x-rays for orthodontic purposes. (4) Prescription drugs and over the counter drugs. (5) Any services involving implants or experimentalprocedures. (6) Any procedures performed for cosmetic, elective or aesthetic purposes. (7) Any procedure to replace or stabilize tooth structure lost by attrition, abrasion, erosion or grinding.

Not all general dentists are capable of performing each of the services listed herein and, based upon the Member’s condition, certain procedures may not be within the scope of practice or ability of a general dentist. In such cases, the general dentist will refer the Member to a California Dental Network participating dental specialist, who will give the Member a 30% discount from their regular fees during the first year of enrollment, and a 50% discount thereafter, for up to $1,000 in services per year. The ratio of premium costs to health services paid, for plan contracts with individuals and groups of 25 or fewer members, during the preceding fiscal year was 0%. * UCR means the dentist’s or specialist’s Usual, Customary & Reasonable fees. # Member is responsible for the payment shown plus the actual lab cost of gold. Orthodontists may charge Members additional fees for costs of cases over 24 months, based on the differences in UCR fees for the needed treatment periods less the UCR fees for a 24-month treatment period.

The California Department of Managed Health Care is responsible for regulating health care service plans. If you have a grievance against your Health Plan, you should first telephone your Health Plan at 1-714-479-0777 or toll-free 1-877-4-DENTAL and use your Health Plan’s grievance process before contacting the Department. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your Health Plan, or a grievance that has remained unresolved for more than 30 days, you may call the Department for assistance. You may also be eligible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a Health Plan related to the medical necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical services. The Department also has a toll-free telephone number (1-888-HMO-2219) and a TDD line (1-877-688-9891) for the hearing and speech impaired. The Department’s Internet Web site http://www.hmohelp.ca.gov has complaint forms, IMR application forms and instructions online.

Posted on Thursday, Apr. 21st 2011 6:47 AM | by Share of Cost | in Share of Cost | Comments Off on California Dental Network Plan Exclusions and Limitations

Share of Cost Dental Plans, California Dental Network

Wednesday, Apr. 20th 2011 6:44 AM

Share of Cost Dental Plans, California Dental Network:  Here is some information on the California Dental Network HMO Dental Plan 411. This dental plan offers individual and family dental services to eligible residents in the household, including their lawful spouse and dependent children. Dependents shall also include all unmarried children under the age of 19 who are chiefly dependent on the subscriber for support and maintenance. Extension of eligibility may be made up to the age of 23 years for unmarried children who are principally dependent upon the subscriber and are registered students in regular, full-time attendance at an accredited school, college, or university (subscriber will be required to submit evidence of full-time status). There are no deductibles and no yearly limits on services, and there are no claim forms to fill out. Your savings are in place when you visit network dentist. You just show up for your dental appointment and make your co-payment – what could be easier?

The dentists must meet the Plan’s standard of quality and service. All have agreed to provide dental care at a low cost available only to its members. There is no waiting period for your dental services to begin, pre-existing dental conditions are covered. A reminder your mail-in application must be received by the company on or before the 20th of the month prior to the following month’s coverage effective date. Review the sample schedule below and see how easy it is for you or your entire family to enjoy these quality dental services.

Posted on Wednesday, Apr. 20th 2011 6:44 AM | by Share of Cost | in Share of Cost | Comments Off on Share of Cost Dental Plans, California Dental Network

Lifestyle Training May Reduce Pain Of Heartburn, Suggests Study

Monday, Apr. 18th 2011 6:24 AM

Patients with the condition commonly known as heartburn may benefit from lifestyle interventions rather than just medication, suggest researchers in this month’s British Journal of General Practice (BJGP).

Posted on Monday, Apr. 18th 2011 6:24 AM | by Share of Cost | in Share of Cost | Comments Off on Lifestyle Training May Reduce Pain Of Heartburn, Suggests Study

Link Between Cough And Reflux Studied With New Sound Recording Device

Saturday, Apr. 16th 2011 6:24 AM

Coughing episodes are closely related to gastroesophageal reflux symptoms in patients who experience chronic cough, irrespective of other diagnoses, according to a new study in Gastroenterology, the official journal of the American Gastroenterological Association (AGA) Institute. Gastroesophageal reflux occurs when the acid contents of the stomach back up, or reflux, into the esophagus.

Posted on Saturday, Apr. 16th 2011 6:24 AM | by Share of Cost | in Share of Cost | Comments Off on Link Between Cough And Reflux Studied With New Sound Recording Device