Medical

DELTA DENTAL

Whether you like it or not, your Delta Dental insurance is now with Delta Dental of California, not Delta Dental of NM. This change occured because DDNM started to charge dentists a $4.00 fee per patient per year which DDCA does not charge. As a result, all of the dentists in Los Alamos and most of the dentists in the area dropped out of the provider network. This enables them to charge whatever they want to charge per procedure. Some of them will still file a claim for you but you have to pay the difference. The difference is less for an in-network provider than for an out-of-network provider.

As a result of these changes you may have trouble finding an in-network dentist. A check of the Delta Dental web site on June 14, accessed through Hewitt, did not list any in-network general practioners in Los Alamos. Four were listed in a 20 mile radius, one in Espanola and 3 in Santa Fe.

Solving the problem will probably cost you money. You can try the following things to find a dentist who will accept a new DDCA patient or if you need to change dentists:

Work your way through the provider list found on the DD web site.
Find a provider who will charge you the difference between DD and their rate per procedure but will still file the claim with DD.
Accept the fact that you have to pay for the procedure but the provider will file the claim for you. You will then be partially reimbursed sometime in the future.
Pay for the procedure and file the claim yourself. You can download a claim form from the DD web site. Make sure you know how to file the claim and what the reimbursement will be. The DD web site lists all of the common dental procedures and what percentage they will pay for that procedure for both the in-network dentist and the out-of-network dentist.

When you talk to the provider and they say they won't accept a DD patient, ask if they will accept you under one of the above conditions. GOOD LUCK!

The best site with by far the most information is the Blue Cross Blue Shield of NM site at www.bcbsnm.com/lanl. You can also contact them by telephone at 1-877-878-LANL (5265). Other sources of information are listed at the bottom of this web page.

It is recommended that you visit the BCBSNM site and register for access to their membership site which they call "Blue Access." You will need a user name and password. While you are there explore the site so you will know how to use it to collect the information you might need in the future.

Prime Theraputics is the company that provides mail order drug service for BCBSNM. Ordering drugs by mail is really fast because the distribution center for this area is in Albuquerque. You can access their web site by going to the BCBSNM web site and clicking on "Prescription Drugs" in the menu bar on the right hand side of the weg page. To get into the Prime Theraputics web site you will need to register with another user name and password. The ones you choose for the BCBSNM site will not work.

The medical insurance card that was issued by BCBSNM is to be used for BOTH doctor visits and prescription drugs. If you have trouble when entering the id numbers from your card into an on-line form try leaving off the letters and only use the numbers. For some mysterious reason, the card has preceeding letters in the id but they are seldom used.

Mail order forms for drugs are available on the BCBSNM web site. You must have Adobe Acrobat reader installed on your computer because the form is in PDF format.

There are several places where you can get some answers about your medical insurance for 2010.

Access the Blue Cross Blue Shield of New Mexico web site, www.bcbsnm.com/lanl or call them at 1-877-878-5265. This is the best site available for insurance and drug plan questions.

Access the Your Benefits Resources web site at www.ybr.com/benefits/lanl. You will need another user id and password to access this site. Here you can change your email address, mailing address, telephone numbers and other profile information. You can also call the Customer Service Center toll-free at 1-866-934-1200 between 8 AM and 9 PM Eastern Time, Monday thru Friday. This site is managed by Hewitt.

Blue Cross Blue Shield has appointed Syd Peavey to be a dedicated claims advocate with Blue Cross Blue Shield of New Mexico and they say "she will be happy to assist you directly with any claims or medical benefit coverage issues". You can contact her by email at Syd Peavey or by telephone at 1-505-962-7277.

For questions concerning the Medicare portion of your health insurance, call Medicare at 1-800-633-4227.

Glen Lockhart has graciously ageed to answer your questions. You can call him at 505-672-3784 or you can email your question to mandmlockhart@cs.com.

MEDICAL INFORMATION

DELTA DENTAL