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Articles
New Oral Cancer Early Detection Tool
Now Offered as Delta Dental Benefit
2004 Cost Containment Report Released
PANDA Program Helps Dentists, Others Fight
Child Abuse
UMDNJ Establishes Dental Education Center
with $2 Million Award from Delta Dental
Staff Spotlight: E.J. Sebelle
Eat Right, Exercise and... Floss?
Just Two Months until Golf Outing
Stay Current with News from Delta Dental - Subscribe
to Consultant News
Delta Dental of New Jersey
is pleased to announce a new benefit that could
have lifesaving consequences for subscribers and
their families.
The brush biopsy is a newly developed procedure that
enables dentists to more easily test patients with
unexplained red and white oral lesions, which may
potentially be an early sign of oral cancer or pre-cancer.
Oral cancer is a life-threatening disease. Only about
half those diagnosed with advanced cases survive
more than five years. Early detection, however, significantly
improves the outlook for long-term survival.
The brush biopsy may assist early detection. This
simple procedure can be done during the course of
a regular exam, and involves little or no discomfort.
In 10% of patients, a dentist may notice an unexplained
red or white spot in the patient’s mouth. Usually,
these spots are harmless, but they can be warning
signs of oral cancer. Until recently, methods for
dentists to tell if a spot had the potential to turn
into cancer were limited.
With the brush biopsy, the dentist uses a small brush
to collect tissue and send it to a laboratory for
testing. Delta Dental of New Jersey covers the brush
biopsy procedure itself upon confirmation of the
laboratory analysis of the specimen. In most cases,
the patient’s medical plan reimburses for laboratory
analysis.
The new technology makes it easier for dentists to
detect oral cancer and pre-cancerous cells. If the
test indicates potential atypical or pre-cancerous
cells, the patient is referred for definitive diagnosis
through a scalpel biopsy.
The brush biopsy is now being taught as standard
practice in many dental schools in the United States.
Delta Dental is developing a continuing education
program for dental professionals on brush biopsy.
The American Dental Association gave brush biopsy
its Seal of Acceptance.
“Oral cancer is a devastating disease,” says
Dr. Scott Navarro, dental director, Delta Dental
of New Jersey. “It can destroy your ability
to communicate and obtain nourishment, as well as
destroy your appearance, and ultimately may take
your life. In spite of advances in cancer treatment,
the survival rate of oral cancer has not risen significantly
in the last 40 years. Early detection is the key
to improving not only the survival rate but also
the quality of life for those victims of oral cancer.
Delta Dental of New Jersey is pleased to do its part
in not only providing benefits for this early detection
procedure but also in educating the public and profession
regarding this valuable new tool in the fight against
oral cancer.”
Delta Dental will also continue to cover traditional
scalpel biopsies for oral cancer.
Oral Cancer Facts
- 8,000 people in the U.S. each year die from oral
cancer.
- 30,000 new cases of oral cancer are diagnosed
each year.
- Oral cancer kills as many Americans yearly as
melanoma, and almost twice as many Americans as
cervical cancer.
- The five-year survival rate for those with advanced
forms of oral cancer is just 57%; it has not improved
in the last 40 years.
- When detected early, oral cancer survival rates
increase dramatically (to 81% or more).
- The average cost of treating an advanced case
of oral cancer is $200,000. Treatment costs for
cancers detected earlier, especially in pre-cancerous
stages, are significantly less.
Who Is At Risk for Oral Cancer?
Oral cancer can strike anyone. At particular risk
are:
- Smokers;
- African Americans;
- Users of smokeless tobacco;
- Those who excessively consume alcohol.
However, 25% of those diagnosed have no risk factors
at all!
- The incidence of the disease is on the rise among
women under 40 and nonsmokers.
More information about
oral cancer can be found at www.deltadentalnj.com;
click on “Brokers,” then
on the “Brush Biopsy Brochure” link.
2004
Cost Containment Report Released
Delta Dental’s cost
containment programs saved groups more than $170.6
million in 2004. We also paid a record $409.1 million
in claims in 2004.
These are among the findings of our 2004 Cost Containment
Report.
Delta Dental of New Jersey reports cost containment
savings in eight key areas:
- In-Network Savings - Reduction of billed
charges to reflect the participating dentist's
filed fee with Delta Dental, the maximum fee level
approved for a DeltaPremier dentist, or the maximum
charge approved under a PPO program. Represents
savings from utilization of network dentists.
- Contractual Limitations - Procedures denied
due to generally accepted dental practice or specific
contract limitations such as performance of a procedure
in excess of a frequency limitation. Also includes
reduction to payments due to Table of Allowance,
reduction to the levels upon which payments of
non-par dentists are based, and PPO tables (when
non-PPO dentists are utilized).
- Eligibility Verification - Benefit denials
for procedures rendered during a period of patient
ineligibility under the plan.
- Non-Covered Services - Benefit denials
for procedures excluded from coverage under the
group program.
- Dentist Consultant Review - Procedures
which are not supported by diagnostic records or
within generally accepted standards of dental care
based on direct review or payment policy established
by Delta Dental's dental consultants. This includes
procedures for which Delta Dental will provide
a benefit allowance for an alternative procedure
that is within the generally accepted standard
of care given the diagnosis or treatment plan.
- Optional Services - Benefit denials or
alternate benefit allowances for dental procedures
that are considered optional and may be performed
at the expense of the patient.
- Non-Billable Services - Procedures that
are not chargeable to Delta Dental or billable
to the patient. Such charges may include component
costs of a more comprehensive procedure which do
not warrant a separate charge, and services denied
as duplicate submissions.
- COB Savings - Claim dollars saved through
the application of coordination of benefit policies
in accordance with the group contract, including
non-duplication COB reductions (where applicable)
and an enforcement of order of benefit determination
rules.
To view the entire 2004
Cost Containment Report, visit our Web site at
www.deltadentalnj.com, click “Brokers” and “Cost
Containment.”
PANDA
Program Helps Dentists, Others Fight Child Abuse
Each year 40,000 cases of abuse and neglect are
reported to the New Jersey Division of Youth and
Family Services. Every 11 minutes a child is reported
abused or neglected in the United States. More than
three children die each day from abuse or neglect.
Would you be able to recognize an abused child?
The signs of abuse aren't always obvious. That's
why the Delta Dental Foundation offers its PANDA
(Prevent Abuse and Neglect through Dental Awareness)
educational program to those who are in regular contact
with children.
PANDA was originally created for dentists, who are
well positioned to detect child abuse. Two out of
every three injuries occur to the head, face, and
neck areas, which are readily visible during a dental
exam.
In recent years, the PANDA program expanded to include
medical professionals, teachers, school nurses, youth
group leaders, and other community group leaders
who can assist in the fight to combat devastating
patterns of abusive behavior.
PANDA presentations provide detailed information
on physical and behavioral indicators of child abuse
and neglect. They also teach how to report, whom
to contact, and how to deal with the sensitive issues
involved in filing a report of suspected abuse.
The PANDA presentation is a one- to three-hour slide
program and workshop conducted by trained professionals.
The PANDA Coalition has members who are willing to
present the program free of charge to dental or other
interested groups with 10 or more members. For more
information or to schedule a presentation in New
Jersey, please call Delta Dental at (973) 944-4555.
In Connecticut call the Connecticut State Dental
Association at (860) 278-5550.
Sidebar: Delta Dental Supports Blue Ribbon Campaign
Against Child Abuse
Delta Dental is an annual sponsor of the Prevent
Child Abuse-New Jersey (PCA-NJ) Blue Ribbon Campaign,
which takes place each April during National Child
Abuse Prevention Month.
PCA-NJ, with the help of hundreds of volunteers,
distributes more than 250,000 blue ribbons throughout
New Jersey. The ribbons remind people of the tragedy
of child abuse and what they can do to help prevent
it.
For more information on PCA-NJ or to learn about
becoming a volunteer for the Blue Ribbon Campaign,
please call (732) 246-8060 or visit PCA-NJ's Web
site at www.preventchildabusenj.org.
For information about other programs to prevent child
abuse, visit the U.S. Department of Health and Human
Services' National Clearinghouse on Child Abuse and
Neglect Information at http://nccanch.acf.hhs.gov/.
UMDNJ
Establishes Dental Education Center with $2 Million
Award from Delta Dental
Delta Dental of New Jersey, Inc., has awarded $2
million to the University of Medicine and Dentistry
of New Jersey (UMDNJ) to establish the Delta Dental
Educational Conference Center in a new Oral Health
Pavilion at the UMDNJ-New Jersey Dental School.
The award will be used to construct three state-of-the-art
lecture halls that can also be combined into one
conference center with a capacity of more than 400.
The Delta Dental Educational Conference Center will
include three conference rooms, a school lounge and
a gallery that serves as a site for events. These
areas of the conference center will comprise nearly
20,000 square feet within the Oral Health Pavilion,
a three-story, 78,000-square-foot facility.
The conference center is part of a $45 million capital
campaign for construction of the new Oral Health
Pavilion and the renovation of the dental school.
Dr. Gerald Sydell, chairman of the board of Delta
Dental of New Jersey, said, "We are proud to have
the opportunity to positively impact dental education
and patient care at the UMDNJ-New Jersey Dental School.
This school is poised to be a leader in dental education
nationally. We believe that the funding will benefit
the public in several important respects, including
advancing dental education and providing care to
the underserved in this state. The educational conference
center will be an integral part of the growth and
development of this fine institution."
Walter J. VanBrunt, president and chief executive
officer of Delta Dental of New Jersey, said, "Delta
Dental is proud to support the UMDNJ-New Jersey Dental
School capital campaign in a manner that will positively
impact the educational setting, foster their learning
environment, and help the university fulfill its
mission to the community."
Dr. Cecile Feldman, dean of the UMDNJ-New Jersey
Dental School, said, "Our capital campaign and the
development of the Delta Dental Educational Conference
Center allow us to expand our reach and focus on
our mission of educating students, conducting research
and providing high-quality oral health care to our
patients. This conference center will create an educational
setting that gives our students an opportunity to
hone their professional skills in a modern learning
environment."
Each lecture hall has executive-style seating and
state-of-the-art audio, video and computer equipment.
Individual learning stations in each lecture hall
will have Internet access for laptop computers. The
Delta Dental Educational Conference Center will be
housed in the Oral Health Pavilion, which is a new
building adjacent to the dental school. The Oral
Health Pavilion includes pre-doctoral clinics for
students, patient waiting areas, administrative offices
and a 3,000-square-foot school lounge.
UMDNJ comprises New Jersey's only three medical schools,
the state's only dental school, the school of health-related
professions, the school of nursing, the school of
public health and the school of biomedical sciences
on campuses in Newark, Piscataway/New Brunswick,
Stratford, Camden and Scotch Plains. UMDNJ also operates
University Behavioral HealthCare in Newark and Piscataway.
It is affiliated with more than 200 healthcare and
educational institutions throughout the state.
Staff
Spotlight: E.J. Sebelle
E.J. Sebelle was still in college when he started
working part-time at Delta Dental. After graduating
from Montclair State University in 1999, E.J. became
our marketing coordinator.
Shortly after starting full-time, E.J. was profiled
in Staff Spotlight. Back then, he called Delta Dental “a
great place to start my career.” He looked
forward to “becoming a jack of all trades,
and eventually, I hope a master of some.”
How has his vision panned out?
“It’s still a great place to work, and
I still handle many different functions,” E.J.
says. He’s also developed expertise in several
areas.
E.J. handles quote requests for voluntary DeltaCare
plans. DeltaCare is our dental HMO product, offered
through Delta Dental’s Flagship subsidiary.
Voluntary plans are those in which employees choose
to participate and pay the cost themselves.
E.J. also handles provider analysis when requests
for proposals (RFPs) come in. This involves comparing
Delta Dental’s dental network to our competitors. “That’s
always a good selling piece because our network is
so large,” says E.J.
He takes pride in the service that he and Delta Dental
deliver to clients. “Our service is second
to none,” E.J. says. “We’re always
willing to go out to see clients, to check in, say
hello, and let them know their business is valued
by us.”
Eat
Right, Exercise and... Floss?
You know that white substance
that builds up between teeth and gums? It is loaded
with bacteria, many of which seem to be perfectly
content to stay in their neighborhoods and eat
away at local surroundings such as gums and jawbones.
But some of these bacteria are more adventurous;
they can get into the bloodstream and end up in
exotic locales like lungs and arteries.
A growing body of scientific evidence indicates that
the bacteria responsible for gum disease can precipitate
or aggravate a number of systemic illnesses, among
them cardiovascular disease, diabetes, respiratory
illness, and pre-term labor in pregnant women.
If that isn’t enough to make you want to keep
a regular date with your dentist, consider this:
Many of these and other diseases also have symptoms
that initially show up in the mouth, offering early
warning signs of sometimes serious medical conditions.
In fact, more than 120 disease signs and symptoms
can be detected through a routine oral exam. Dentists
are often the first to detect cancerous or pre-cancerous
lesions in the mouth. They can often spot other diseases
as well, including anorexia and bulimia, hepatitis,
anemia and, in some cases, the presence of AIDS by
detecting oral infections that come from a compromised
immune system.
On its own, poor oral health can impact time away
from school and jobs. The Surgeon General reports
51 million school hours are missed each year due
to dental-related illnesses. For adults, more than
164 million work hours are lost each year due to
dental problems.
According to the Surgeon General, “Oral health
is integral to general health. You cannot be healthy
without oral health.” Illustrating the point
are statistics showing the prevalence of specific
diseases and ailments and their relations to oral
health:
- More than one in three people age 30 and older
have periodontal disease.
- Severe periodontal disease affects about 14%
of adults aged 45 to 54.
- Pregnant women with periodontal disease are seven
times more likely to give birth to a low-weight
or pre-term baby. Almost 20% of pre-term and low-weight
births can be linked to periodontal disease.
- Oral and pharyngeal cancers are diagnosed in
about 30,000 Americans annually; 8,000 die from
these diseases each year.
- In a recent study, people with rheumatoid arthritis
(RA) were more than twice as likely to have periodontal
disease with moderate to severe jawbone loss than
those without RA. RA patients also averaged 11.6
missing teeth, compared to 6.7 in the control group.
Doctors conclude that there is still much to learn.
But the findings so far underscore the importance
of regular, preventive dental care, and they emphasize
the key role that dental health plays in overall
health.
Just
Two Months until Golf Outing
The 15th Annual Delta
Dental Golf Classic takes place June 22 at the
Fiddler’s Elbow Country
Club in Bedminster, New Jersey. The annual event
benefits Special Olympics New Jersey (SONJ). SONJ
is a non-profit organization that provides athletic
training and competition for children and adults
with developmental disabilities.
Registration and sponsorship materials are available.
For more information, please call Jennifer Appaluccio
at (973) 285-4059.
Stay
Current with News from Delta Dental - Subscribe
to Consultant News
Delta Dental now offers two publications for brokers
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