Friday, May 18, 2012

Will a better Dental Plan reduce Your Company's curative Claims?

Cigna Health Plan - Will a better Dental Plan reduce Your Company's curative Claims?
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What if you could reduce those sky-high health insurance costs through your much-cheaper dental plan? New study suggests you might be able to do just that.

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It's logical if you ponder it. Your mouth contains about six billion bacteria of up to 400 species at any given time. And how many hundreds of times per day do you swallow?

Add to that study studies that show that lasting inflammation such as that complex with periodontal (gum) disease can lead to heart disease, particularly if diabetes is also present. Moreover, in one study pregnant women with periodontal disease were approximately twice as likely to have an early delivery as women without periodontal disease or those who were properly treated. And a premature baby can cost 0,000.

What's missing in the argument is the proven cause/effect relationship. Heart disease and periodontitis ordinarily occur in the same folks. So do periodontitis and premature delivery. But that's not the same as actual cause and effect.

As Dr. Miles Hall, chief clinical director for Cigna, a leading health and dental insurer, puts it, "I'll be very frank: The studies that are out there show a strong association. At this point, they do not necessarily show a causal relationship."

Part of the presume for the lack of causal association is the lack of random studies. What they've absolutely done is to look at the fraction of citizen who have diabetes and periodontal disease and who also make heart disease. But some citizen with diabetes may go to the dentist commonly and get their gums cleaned appropriately. Those same citizen may also be more true about measuring and controlling their blood sugar and may thus conduce to understating the health risks from poor dental practices.

What Carriers Are Doing About It

Two major insurance carriers, Cigna and Aetna, (both of whom write both healing and dental plans) are identifying the insureds who are at risk for heart disease:

those already identified, those with diabetes and those who are pregnant.

They reach out to the employees to try to get them to the dentist for an assessment of their dental health. After reaching out by mail and email, they'll absolutely call them if they haven't seen their dentist within a prescribed time period.

Is it worth it? Well, look at these facts:

* Stroke victims who got periodontal medicine prior to their stroke spent ,000 per year less than those who only got the medicine after their stroke.
* Diabetes patients who got acceptable care for periodontal disease saved the carrier ,418 annually in healing costs.
* Avoiding a premature birth can save as much as 0,000.

What Employers Can Do About It

The challenge is that your dental and health carriers are probably two separate insurers. It's much harder to coordinate between two carriers than it is when there's only one.

But it's not impossible. By setting up a properly structured health reimbursement Arrangement (Hra) and well-communicated wellness program, you can start your own claims allowance program.

For example, here are some provisions to consider:

o If an employee has diabetes and also has periodontitis, he or she will be allowed to get one rot scaling and planing paid for by the Hra. The employer will reimburse any deductible or coinsurance incurred in the process.
o Furthermore, ongoing cleanings can be covered in full up to four times yearly (some dental carriers are already doing this for insureds with gum disease.)
o Likewise, employees diagnosed at risk for heart disease and pregnant women with periodontitis will also be eligible for no-cost periodontal treatment.

In structuring such a program it's crucial to coordinate via an outside administrator so as to avoid running afoul of Hipaa restrictions. It's a long-term payoff, but it could well be worth your company's effort.

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