<p>preventive care does reduce all of the above when it “finds” something in an individual. But the total cost of all of that screening – and false positives resulting in unnecessary procedures – tends to exceed any financial benefits obtained from finding (individual) stuff early across the entire population.</p>
<p>**Moderator’s Note</p>
<p>Again, if you are here to post supporting and opposing posts about ACA, this thread is not for you. This is not an opinion thread. **</p>
<p>“Not so incidentally, my youngest daughter has a potentially life-threatening health condition that is normally diagnosed when? You guessed it! During pediatric dental care! We were an exceptionally rare case where it was diagnosed at birth, and the doctors told us that pediatric dentists could catch it in the manageable stage but if they didn’t (or if there was no pediatric dental care) then it was usually fatal by the time non-dental symptoms appeared.”</p>
<p>Wow cosmicfish. I hope everything works out. The best to you and your daughter.</p>
<p>"Yearly dental checkups can be had for $25.00. It’s like car insurance covering an oil change. If people don’t do that it’s not an insurance issue.</p>
<p>How common are yearly dental checkups that cost $25? </p>
<p>What is done for $25?</p>
<p>I doubt that I could shop around and find a dentist who would give me a checkup for $25 in my area, which I think is pretty close to dstark’s. I don’t think our very populous area is a place where $25 dental checkups are available.</p>
<p>[San</a> Francisco, CA Dentist | Dentist 94110 | Gentle Dental](<a href=“Gentle Dental Community San Francisco - Gentle Dental”>Gentle Dental Community San Francisco - Gentle Dental)</p>
<p>You are correct. In your area it appears $59.00 is the going rate, but I did not shop around so maybe we could find a cheaper one. However, I imagine we could agree SF is not representative of the costs around the country.</p>
<p>Gosh, my dentist charges me $90 for a check-up and cleaning. </p>
<p>I have no idea what my H and DS are charged at their in network dentist because we don’t pay anything for that and I don’t read the Explanation of Benefits when it comes in the mail.</p>
<p>I have seen dental bills much larger than 90 for my kids.</p>
<p>At what age are they non-pediatric?</p>
<p>^ more than $90 for just a cleaning and check-up (not including x-rays?)</p>
<p>I pay 120.00 for just a cleaning. Cash. But that’s because I go the dentist I want to go to and I can pay him. But I have at various times in my life needed to find deals and if you’re paying cash it’s not hard. They are pretty common. I get flyers in the mail for $29.00 regularly and my area is not among the least expensive either. </p>
<p>Most interesting to me is that Emily has no idea what she pays because insurance pays. See, if you’re the one paying, you care.</p>
<p>I just went to NJ BCBS website to see what they said about ages for pediatric dental since I’ve read under 19, and 19 and younger. My DS is 19.</p>
<p>Imagine my surprise when all 4 plans offered on the individual market (non-marketplace) do NOT cover pediatric dental. I thought that was one of the essential benefits that had to be offered. Instead you have to buy an exchange certified stand alone dental plan for an additional charge.</p>
<p>The reason that you have to buy a separate policy for dental is relatively simple: historically that insurance has been provided by different companies. That is, for example, Blue Cross Blue Shield doesn’t write dental coverage, but Delta Dental does. BCBS can set it up so that they can sell Delta Dental via their web site for your convenience, but it is still a different company, different underwriting criteria.</p>
<p>Flossy, where did you get the $25 and $59 numbers? I checked out your link and I dont see $59.</p>
<p>Ok…a flyer for $25.</p>
<p>I pay $179. I go twice a year. My dentist and hygenist are great. I can go to a different place and the price will be slightly lower. Slightly. My kids pay more than $100. Different dentist.</p>
<p>$59 is the going rate around here?</p>
<p>That is a shock! :)</p>
<p>You can go to UCSF and have a dental student see you the first time for under $25. Then the costs increase.</p>
<p>“Most interesting to me is that Emily has no idea what she pays because insurance pays. See, if you’re the one paying, you care.”</p>
<p>I know what I am paying because my dentist is not in my network. </p>
<p>What I do not know is what my ins. co is paying the in network dentist because check-up and cleanings are covered 100%. I am sure the in network dentist is getting paid less than my out-of network dentist because that price has been negotiated between the provider and insurance company.</p>
<p>"more than $90 for just a cleaning and check-up (not including x-rays?) "</p>
<p>When they were kids they had cavities or other needs.</p>
<p>calmom - so how does the pediatric dental requirement get fulfilled? If you don’t buy anything from Delta Dental, does it become optional but offered?</p>
<p>“When they were kids they had cavities or other needs.”</p>
<p>Ah, I wasn’t including stuff like that - I just thinking of cost for cleaning and checkup. </p>
<p>My S just had to have a cavity filled last summer and since he didn’t want amalgam the cost was $60 for the filling - but the rest was all covered by our insurance.</p>
<p>Delta Dental does not have exchange certified plans in NJ. I can’t seem to find who does. I don’t need it, but just curious.</p>
<p>From NJ BCBS website:</p>
<p>"The Affordable Care Act (ACA) permits plans outside of the Health Insurance Marketplace and the Small Employer Health Options Program (SHOP) to issue coverage without pediatric dental benefits only if reasonably assured that the applicant has purchased an exchange-certified stand-alone dental plan (SAPD) covering the pediatric dental benefits as required by ACA. In order to receive reasonable assurance from you, we require the following information:</p>
<p>Yes, I have purchased an exchange-certified stand-alone dental plan </p>
<p>No, I have not purchased an exchange-certified stand-alone dental plan</p>
<p>The Applicant attests that the above information is accurate and agrees to hold us harmless from any harm, monetary loss, or liability in connection with reliance on your representation. The Applicant also agrees that Horizon BCBSNJ may require you to submit information demonstrating your coverage under an exchange-certified stand-alone dental plan and may request evidence of coverage and/or the name of the issuer and applicable policy number. The Applicant agrees to provide this information immediately upon request."</p>
<p>Well but we are talking about the cost, not just what we pay right?</p>
<p>
I have confirmed with both Blue Shield and with my insurance agent that the rates on the grandfathered plans ARE going up. However, that doesn’t mean that BS has sent out the premium increase notices yet. Historically I think I’ve always gotten the notices after the 1st of the year, so I’d anticipate those notices will go out between January-March. </p>
<p>And there is ALWAYS a premium increase. I can not remember a time, ever, that rates didn’t go up from year to year. Sometime the increases were smaller than other times, but I think it would be very unrealistic to think that there won’t be an increase. </p>
<p>
Yes, but as of now they haven’t really clearly published information about their ACA-plan networks either. About the only thing I have been able to confirm for certain is that Blue Shield’s networks won’t include the UC hospitals. I think that the dropping of Cedars Sinai is also certain, mainly because Cedars has published that info on their own site. Keep in mind that the decision whether to participate in the network is a mutual one – that is, it’s a matter of price negotiation. If Cedars or UCLA come to BS or Anthem and say they want to join and will accept the insurance companies negotiated pay rate, they’ll be added. </p>
<p>
Did their doctors agree with that assessment? Generally if there is a unique circumstance where the facilities to treat a certain condition simply aren’t available, the insurance company will pay out of network. For example, if a person needed a liver transplant to save their lives, and the only facility in the region that can do organ transplants is out-of-network - then that person is going to be transferred and the bills paid. It’s just that it’s more common that the patient’s desire to be treated at an out-of-network facility is based on a perception of quality rather than a case of lack of services at the in-network hospital. </p>
<p>
Yes, but insurance is not always available for every risk. I live in the San Andreas fault, and I used to have earthquake insurance, but after the Loma Prieta earthquake the rates and deductibles just got too high to be affordable for me. I have to accept that in the event of major earthquake damage I’d have to eat the loss. It may be that the insurance companies are now mandated by law to cover just about everything, but that given that requirement, they are going to be very cost conscious about the facilities they use.</p>
<p>jbsmom, I was just using Delta Dental as an example-- I’ve never had dental insurance so I really don’t know the names of the various companies doing business. My point is simply that it’s a different product than health insurance, which generally is offered by different companies - and that is the reason you may end up having to buy as an “add on” rather than automatically have it included in the plan.</p>
<p>
I haven’t really looked into it, but I think that parents who are eligible for subsidies will have the pediatric dental premiums included at no extra cost to them - that is, if their income level means that the maximum they can be charged for insurance is $450/month, then they will pay $450 for health + dental. Adult dental would be extra because it is not included on the essential benefit list.</p>
<p>I think that whether the parent of a minor is required to buy the pediatric dental is determined on a state-by-state basis. See: [Obamacare</a> and kids dental. vision coverage - The Washington Post](<a href=“http://www.washingtonpost.com/national/health-science/obamacare-and-kids-dental-vision-coverage/2013/10/14/1b0183e2-3108-11e3-8627-c5d7de0a046b_story.html]Obamacare”>http://www.washingtonpost.com/national/health-science/obamacare-and-kids-dental-vision-coverage/2013/10/14/1b0183e2-3108-11e3-8627-c5d7de0a046b_story.html)</p>
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