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Get Listerine fluoride for free with Obamacare – maybe

January 30, 2017 By Trish Walraven Leave a Comment

magtodd

I feel very targeted right now.

It’s because I’m one of the 16% of Americans that everyone is fighting to either “guarantee insurance” for or “force insurance” upon, depending on which side of the aisle you stand.

You see, my family has Obamacare.

It’s not because we can’t afford anything else. It’s because there simply is no other major medical care available for small employers who either aren’t required to offer insurance to their employees or cannot obtain group insurance because of the size of the company. We privately purchase the exact same plan offered on the Marketplace; it’s off the exchange, though, so there are no subsidies.

Here’s the cool (mint?) reason for mentioning this on DentalBuzz. As part of a family that’s enrolled in a plan that was created due to Obamacare, I discovered by accident that there’s a way to get Listerine fluoride rinse for free.

What happened is that I was browsing through the 2017 drug formulary from my insurance company and found something called the ACA Tier. Almost every exchange-eligible plan has a No-Cost Preventive Drug List like this one from Blue Cross Blue Shield of Texas. It states in part:

Your health plan may include certain prescription and over-the-counter (OTC) preventive medicines, as a benefit of membership, at no cost to you when you use a pharmacy or doctor in your health plan’s network. There is no co-pay, deductible or coinsurance, even if your deductible or out-of-pocket maximum has not been met. Coverage for these medicines can vary according to the type of plan you are enrolled in…. Age limits, restrictions and other requirements may apply.”

So I’m going down the list and notice several entries for Listerine:

ACAFLSuppl

How can I get my free bottle, that’s what I said to myself when I read this. You want your free bottle too? Not so fast. All ACA-qualified plans are only required to cover fluoride for children under age 6. Which may mean that if you have children enrolled in Obamacare and they’re preschoolers, all you may have to do is to take your child’s bottle of Listerine up to the pharmacy window, present the insurance card, and they’re supposed to zero out the expense for you. I called my insurance company and this is what they stated. You’ll need to check your own benefit booklet first, though, because some plans only cover fluoride in other forms.

As a dental hygienist and mom, though, what’s a little perplexing is trying to figure out the label directions. We’ll go after this bottle of Listerine Smart Rinse, cause it’s cute and tough all at the same time.

smartrinseanticavityToddler-friendly? Check again.

SMRinseLabel

 

There is a huge disconnect between the FDA and the ACA, and it shows on this label! The Food and Drug Administration says you shouldn’t give it to children under six without consulting a dentist or doctor, but the Affordable Care Act pays for its use only for children that age.

Anyway, we all realize that healthcare in the United States is a work in progress. In other words, it’s a mess, right? And most of us are very much out of our element when we’re trying to figure out what’s covered and what’s not. Did you know that even most dentists and hygienists are clueless about fluoride benefits and the ACA? The only reason that I know anything myself is because I did a bit of sleuthing, found a lot of the Obamacare plans in each state, read their Preventive Drug lists, and then compiled the research. Sure, this article starts off with a little Listerine click-bait (hah! Social Marketing 101 – make ’em look!) but I do want to offer some important education, too. Here goes.

FLtabs• What do all ACA-qualified plans have in common with each other? At the very least, every insurance policy must include fluoride supplementation at no cost for children under age 5. Supplements are recommended mostly in areas where the fluoride level in water supplies are inadequate, and age five and below is the time frame when teeth can be protected most by the ingestion of fluoride. The supplements can be in the form of drops, chewable tablets, or as combination vitamins. All fluoride supplements require a prescription, either from a dentist or a physician’s office.

• Many health plans also pay for the in-office topical application of fluoride varnish. This is covered by the medical side of the plan, not the dental benefit, so you should either be savvy with using the medical code (CPT 99188) or leave it in the pediatricians’ sticky hands. Haha, sticky hands. If you’ve ever worked with fluoride varnish, it sticks to evvvverrrrry thing if you’re not careful. But hey, it’s why varnish can give up to six months of cavity protection, too. Some plans cover fluoride varnish applications as an unlimited benefit, however, I found that most plans pay for no more than two applications per calendar year.

prevdnt

• Some of the plans reviewed include prescribed and/or over the counter (OTC) topical fluoride gels, pastes, and rinses, such as the previously mentioned Listerine Fluoride, Act Rinse, Prevident, Fluoridex, Gel-Kam, Clinpro 5000, Phos-Flur, Omni Gel and others. A few of the plans even list brand-name toothpastes, although I wouldn’t count on those getting covered.

Although I reviewed somewhere in the range of 50-100 healthcare plans available, I can’t tell you specifically which fluoride products are covered by, say, Cigna versus Aetna, because they vary so much between states. You’ll have to read your plan, or better yet, call your insurance company. Be sure to share what you discover with your dentist, hygienist, or physician, so they can help your kids get the fluoride prevention that you’ve already pre-paid for.

Because, let’s face it, pre-payment is what preventive healthcare insurance is, anyways. You only “pay an ounce” for prevention, after all, so you should get at least that much back. Especially when a pound – 16 fluid ounces – of Listerine fluoride costs your insurance company only five bucks.

It sure beats the bill for a pound of actual cure.

 

 

TWimage1

Trish Walraven, RDH, BS is a dental hygienist from the Dallas/Fort Worth area who cropped out her lovely daughter in this photo because it’s very, very obvious that she’s older than five. She didn’t want the Obamacare Police to have anything on her if she did show up at the pharmacy begging for her “free” bottle of bubble-gum fluoride rinse.

 

 

References and resources

United States Census Bureau, Health Insurance Coverage in the United States: 2015 https://www.census.gov/library/publications/2016/demo/p60-257.html

Aetna Health Care Reform Preventive Care Drug List: https://www.aetna.com/content/dam/aetna/pdfs/formulary/2016_HCR_Preventive.pdf

American Academy of Pediatrics – Oral Health Coding Fact Sheet for Primary Care Physicians: https://www.aap.org/en-us/Documents/coding_factsheet_oral_health.pdf

Science-Based Medicine. Preventing Tooth Decay in Kids: Fluoride and the Role of Non-Dentist Health Care Providers https://sciencebasedmedicine.org/preventing-tooth-decay-in-kids-fluoride-and-the-role-of-non-dentist-health-care-providers/

Kaiser Family Foundation. Health Insurance Coverage of the Total Population: http://kff.org/other/state-indicator/total-population/?currentTimeframe=0

United Healthcare. Topical Fluoride Treatment Dental Clinical Policy: https://www.unitedhealthcareonline.comTopical%20Fluoride.pdf

Humana Pharmacy Solutions. $0 Preventive Medication Coverage: http://apps.humana.com/marketing/documents.asp?file=2838979

Kaiser Permanente. Preventive Services Flier: http://apps.humana.com/marketing/documents.asp?file=2838979

Filed Under: Featured, Preventive Care, Products Tagged With: Affordable Care Act, Fluoride, obamacare, Preventive Care Drug List

Only God can explain the ACA to dentists

January 21, 2014 By Trish Walraven 4 Comments

 

HeavenDental2

 Why I was chosen for such a task? I didn’t ask for this. Okay, so maybe I did.

Years ago I swore off direct petitioning prayer; you know, the kind where you ask God directly to intervene in the course of human events. Like, please help me to lose weight (that’s just BEGGING for a tapeworm there!) or any other sort of prayer that you ask God to help you in a specific way.

Except this time I forgot to not be so direct.

A few weeks ago I must have quietly asked God if He could help me make sense of Obamacare and how the Affordable Care Act is going to end up affecting dentistry in the next few years. And I had a dream that I would find the answer, only that it was buried and that I would get a signal when it was time to dig.

Dig? As in Joseph Smith, dig? Dude, angels aren’t my thing. Not that I have anything against angels pointing their fingers to the ground and making me do all the hard work.

Fortunately no angel came to me. Instead it was a cricket, chirping in the middle of winter like no cricket should. There’s this closet in a corner of one of my operatories, it’s the hidden closet, it’s where we cram in the Christmas tree every January above the forgotten manual x-ray film developer and all the manila patient files from twenty years ago. All day I was tormented by the shrillness of that annoying survivor. Even after the last patient was gone the cricket continued its unwavering tone. Was that my sign? I began digging in the closet, searching for the little critter.

When I pulled out the second box of files, there it was, No, not the cricket, but three unassuming sheets of stationery, triple-folded and clinging to each other. The weird part, though, was that there was not actually any writing ON the pages, per se. Instead, the words were like cutout stencils, as if a brood of silverfish had only eaten away the paper where the ink had been. I shouldn’t have been surprised, really, but I figured that Someone had gone through all the trouble to stash the revelation in our dental closet; the least I could do was to transcribe the contents of the document here at DentalBuzz.

This, then, is:

The Fresh Testament for the Everlasting Dentition

Chapter 1

1. In the beginning, there were gingiva, and they were good. 2. As suckling begat the need to chew, the eruption of the primary teeth ensured proper consistency for bodily nourishment. 3. But childish things must be put away, as youth becomes adulthood, the shedding of the smaller allows for the growth of that which is more permanent. 4. The gift of teeth is therefore given to all freely, to last until the final breath of life.

Chapter 2

1. Know your enemies; otherwise they will be your undoing. 2. Beware of acid, and biofilm, and parafunction, for they may cause destruction. 3. Combined, they will hasten the evacuation of teeth from your mouth. 4. Seek refuge in the wisdom of those who are learned about the enemies of the dentition, for they will give you comfort and aid, and you will forever be guided towards pearly dental glory.

Chapter 3

1. The ways of the world take the unaware down the pathways of fear, uncertainty, and doubt. 2. The earlier generations of servants saw their wages frozen so that all would not perish from the earth after the second great war. 3. Thus the idea of a dental benefit was created. 4. The dental benefit is a substitute for actual earnings. 5. The first days of the dental benefit helped many people fight the enemies of their teeth, by sending earnings directly to the physicians of the mouth. 6. The physicians saved teeth with those dental benefits that were given to them instead of directly to those who had served their masters, and all was well. 7. A vast outpouring flooded all the land with a large booming of babies, and as they ripened they began their search for work. 8. No longer were dental benefits under the rein of the masters themselves; instead, they were passed to those who promised to look after the servants’ best interest as an insurance against the loss of teeth. 9. Verily, a seed was planted in the minds of many: if a servant does not have an insurance policy, one cannot attend the services of a dental physician. 10. And God wept when He saw that His children first began to believe they could no longer care for themselves with their own earnings.

Chapter 4

1. Those that promised to look after the servants and insure them against harm wanted to control dental physicians, and for many years the physicians resisted. 2. Three tribes arose in the struggle to attend to the care of the Children of God: the Fee For Service, the Preferred Provider, and the Single Payer. 3. While the lands where the three tribes practiced were not the same, as some were less hospitable than others, all tribes found that they could attend to those who were able to seek their services.

Chapter 5

1. Then in all the lands a clamor of discontent from the servants and their lords created a large cloud that poured out from the District of Columbia. 2. When the dust settled from the cloud it revealed that the tribes were not disbanded, and that those they served would continue to attend to their care to perpetuate the saving of teeth. 3. But with the servants, they felt a fear growing even larger in their hearts that made them feel helpless about affording the ability of themselves and their kin to smile and chew and not feel dental pain, and the care of the dental physician seemed even more unreachable.

Chapter 6

1. A revelation is near: know that the purpose of this Cloud of Obamacare is to assure the Everlasting Dentition for all. 2. But it will not be without struggle, because the Cloud itself is not the answer. 3. More care will be mandated, but the cost to the servants will cause a great frustration. 4. The dutiful will pay excessive amounts for their allotments yet they will not be blessed with their choice of caregivers.  5. Blessed are the children, for they will be adults some day and if every one of them for many years is required to visit a dental physician, then the proof of those efforts will be rewarded. 6. And it will be known that it is the act of visiting the dental care provider that saves teeth, not the insurance itself, and the eyes of all the people of the lands will be opened, and their hearts will be changed. 7. And the people will no longer look to their masters to care for them, for they themselves will know that they are partners in maintaining the gift of teeth that was given to all freely.

_____

Yeah, so see? God just wants to stay out of Obamacare. He has no place in it, or in politics at all for that matter.

I probably don’t either, but from the new dental health plans that are available here in Texas I can comfortably say that the dental “insurance” you receive from any of the Obamacare coverage ends up costing more than just paying a dentist directly. It is too much of a hassle to give your money to a third party and then ask for some of it back, which is, in essence, what you are doing.

In the meantime, though, I’ll try to stay out of that closet.

 

 

 

 

Filed Under: Anecdotes, Humor Tagged With: Affordable Care Act, dental insurance, dental satire, dentists and the affordable care act, How does Obamacare affect dental insurance, Obamacare and dentistry

About

DentalBuzz explores rising trends in dentistry with its own slant. The speed at which new products and ideas enter the dental field can often outpace our ability to understand just exactly the direction in which we are heading. But somehow, by being a little less serious about dentistry and dental care, we might get closer to making sense of it all.

So yeah, a tongue-in-cheek pun would fit really nicely here, but that would be in bad taste. Never mind, it just happened anyways. Stop reading sidebars already and click on some content instead.

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