Braces: Keeping cost down and insurance questions.

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fortfun
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Braces: Keeping cost down and insurance questions.

Post by fortfun » Sat Jul 14, 2018 1:27 pm

Any advice on keeping the cost of braces to a minimum? I've got 2 kids that will need them in the next few years.

Also, my wife and I can both pay more for dental plans that cover $1,800-$2,000 of the cost. Is there any way for both of us to utilize our insurance, or is it one or another. I can't get a clear answer from anyone. I'd like to have my wife pay for extra insurance for the first half and then I'd pay for extra insurance for the second half. The orthodontist offices seem to indicate that this isn't possible.

Does the price vary greatly by region? I understand there are a lot of appointments but I'd be willing to travel 50 miles a few times to save a few grand.

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gasdoc
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Re: Braces: Keeping cost down and insurance questions.

Post by gasdoc » Sat Jul 14, 2018 1:32 pm

I can only answer the second part- I wouldn't go outside your general area, as there are LOTS of visits, and not everyone can have the slot right after school because all of the patients are students (well, the vast majority). Are you really going to take your kid out of school for the entire day instead of a couple of hours to drive them an hour each way in addition to the time in the office? I would stay local.

gasdoc
Last edited by gasdoc on Sat Jul 14, 2018 5:56 pm, edited 1 time in total.

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fortfun
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Re: Braces: Keeping cost down and insurance questions.

Post by fortfun » Sat Jul 14, 2018 1:47 pm

gasdoc wrote:
Sat Jul 14, 2018 1:32 pm
I can only answer the second part- I wouldn't go outside your general area, as there are LOTS of visits, and not everyone can have the slot right after school because all of the patients students (well, the vast majority). Are you really going to take your kid out of school for the entire day instead of a couple of hours to drive them an hour each way in addition to the time in the office? I would stay local.

gasdoc
Thanks Gasdoc. Probably not but I'm about 30 minutes to another state (bypassing the city). Sometimes the drive across the city, where the dentists are, takes thirty minutes. I guess if I could save 2k, I'd drive out of state. Since I'm not in the business, I don't know how rates change by region. I appreciate your input. In the end, I'm sure we will stay in town.

livesoft
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Re: Braces: Keeping cost down and insurance questions.

Post by livesoft » Sat Jul 14, 2018 1:53 pm

One of our children got braces. We shopped orthodontists and found the following:

1. In wealthy areas, there are too many orthodontists, so the potential mouths per orthodontist are less than in an area with same population density with fewer orthodontists.

2. With less competition, the orthodontist can charge less to get the same standard of living because they get more mouths.

3. So we picked a well-recommended orthodontist not in our area, but about 20 miles away and saved some money.

4. We did not have "lots of visits." Also, dentists recommended pulling wisdom teeth and we did not have that done. The adult child often gets compliments on her smile / teeth, so those results speak for themselves.
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Determined
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Re: Braces: Keeping cost down and insurance questions.

Post by Determined » Sat Jul 14, 2018 2:01 pm

One insurance is primary, the other can be secondary. You won't be able to switch and get the coverage twice. I have no experience with opting for a different coverage that pays more. My third child will get them next year. I have an HSA, but once I get the estimate next month, I will use a limited FSA in 2019 to cover the balance of the braces. This way I can keep the HSA as an investment account and use pre tax money for the orthodontics. I will pay for it all immediately on a 2% cash back credit card and receive a 5% discount for being paid in full. Then I will submit for reimbursement which should arrive before my credit card payment is due.

I could also open a new card with a bonus. I have done that a few times.

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Summit111
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Re: Braces: Keeping cost down and insurance questions.

Post by Summit111 » Sat Jul 14, 2018 3:44 pm

I made a deal with the orthodontist for an upfront CASH payment of the total copayment of my kids treatment. He collected whatever the insurance payments were. Saved 30%....

Summit

Rupert
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Re: Braces: Keeping cost down and insurance questions.

Post by Rupert » Sat Jul 14, 2018 4:04 pm

Do you and your wife both have dental coverage right now, or could you stack enrollment in your respective plans, i.e., enroll the family in your plan for a couple of years and then enroll the family in her plan for a couple of years? If the latter, then I think maybe you could get both plans to pay out the maximum benefit for orthodontia.

I think the number of visits depends on the exact treatment your kid is receiving. I know kids who go every week for months at a time, which would make the 50-mile trip a pain. I picked an orthodontist across the street from my kids' school for that very reason.

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Re: Braces: Keeping cost down and insurance questions.

Post by EHEngineer » Sat Jul 14, 2018 4:21 pm

livesoft wrote:
Sat Jul 14, 2018 1:53 pm
One of our children got braces. We shopped orthodontists and found the following:

1. In wealthy areas, there are too many orthodontists, so the potential mouths per orthodontist are less than in an area with same population density with fewer orthodontists.

2. With less competition, the orthodontist can charge less to get the same standard of living because they get more mouths.
While I believe that orthodontists are more expensive in wealthy areas, your explanation that somehow the market is rationing mouths to orthos to ensure equal standards of living would be novel. Worthy of publication for sure. I suggest that rent and labor costs are higher in HCOL areas, price sensitivity is lower, and customer demands for posh facilities may also be higher.

back to thread subject

Edit to add: We chose the nearby ortho because it's convenient and everybody we spoke to loves him. We paid in full upfront for a substantial discount 20-30% from memory. They did warn us that if our insurance benefit is reduced during the treatment, we would need to pay for that.

about using two insurances. I had dual insurance for a while, I think they would both pay up to their cap. There would be a primary and secondary where the primary insurer is the insurance company of the older of the two primary insureds, ie you or your wife. The ortho would need to submit the claims twice, and sequentially, not simultaneously. As long as the costs exceed the benefit of the primary insurer, then the secondary should kick in up to its limit. That's how it worked for me. It was pretty messy, and the primary will keep asking you with emails and snail mail "Are you sure I'm the primary insurer? Please send us documentation of ....."
Last edited by EHEngineer on Sat Jul 14, 2018 4:48 pm, edited 2 times in total.
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Tanman4223
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Re: Braces: Keeping cost down and insurance questions.

Post by Tanman4223 » Sat Jul 14, 2018 4:32 pm

Fortfun,

If you do not have a HDHP for your insurance, I would suggest checking to see if your employer offers a healthcare FSA. This would allow you to pay for the entire amount without federal taxes, social security contributions and possibly state taxes. You’re money would stretch farther and realized income would be reduced. If you didn’t want to pay each fee in total upfront, you could ask if the orthodontist would split the payment in two and pay in two different years with the FSA to lighten the load.

drawpoker
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Re: Braces: Keeping cost down and insurance questions.

Post by drawpoker » Sat Jul 14, 2018 4:39 pm

Be very, very cautious with dealing with childrens orthodontists and dental insurance plans.
When I had dental coverage at work it offered orthodontists benefit but you had to stay within network. At the initial visit for the in-network one with an office nearby was told the kid would need two teeth (not wisdom) pulled. Explanation being that the braces would not fully do the trick without this teeth pulling.
Did a little checking, and sure enough, found out some orthodontists pull this on unsuspecting parents with certain insurance plans. Apparently pulling teeth first makes the whole job of applying braces much easier, less time and effort.
Evidently this one was not satisfied with the payment rates he was getting from the insurer so he was looking for any short cuts he could.
Naturally, I consulted another orthodontist (not in network) who said absolutely not, we have no reason to pull healthy teeth prior to putting on braces.
Then I had to battle with the insurance company to approve allowing me to go out-of-network for services.
It was a hassle, but it was finally granted. Probably because I had some rather damning documentation of just how their in-network orthodontists were doing business.

livesoft
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Re: Braces: Keeping cost down and insurance questions.

Post by livesoft » Sat Jul 14, 2018 5:12 pm

EHEngineer wrote:
Sat Jul 14, 2018 4:21 pm
While I believe that orthodontists are more expensive in wealthy areas, your explanation that somehow the market is rationing mouths to orthos to ensure equal standards of living would be novel. Worthy of publication for sure. I suggest that rent and labor costs are higher in HCOL areas, price sensitivity is lower, and customer demands for posh facilities may also be higher.
This article supports your view: https://orthopundit.com/orthodontics-is ... -is-right/
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gasdoc
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Re: Braces: Keeping cost down and insurance questions.

Post by gasdoc » Sat Jul 14, 2018 5:59 pm

Rupert wrote:
Sat Jul 14, 2018 4:04 pm
Do you and your wife both have dental coverage right now, or could you stack enrollment in your respective plans, i.e., enroll the family in your plan for a couple of years and then enroll the family in her plan for a couple of years? If the latter, then I think maybe you could get both plans to pay out the maximum benefit for orthodontia.

I think the number of visits depends on the exact treatment your kid is receiving. I know kids who go every week for months at a time, which would make the 50-mile trip a pain. I picked an orthodontist across the street from my kids' school for that very reason.
Yes, that was our experience. And if your kid has after-school activities and/or challenging classes, it can be rough.

gasdoc

AlphaLess
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Re: Braces: Keeping cost down and insurance questions.

Post by AlphaLess » Sat Jul 14, 2018 6:06 pm

drawpoker wrote:
Sat Jul 14, 2018 4:39 pm
Naturally, I consulted another orthodontist (not in network) who said absolutely not, we have no reason to pull healthy teeth prior to putting on braces.
Anybody who would suggest pulling healthy teeth out needs to have some neurons pulled from their brains.

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fortfun
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Re: Braces: Keeping cost down and insurance questions.

Post by fortfun » Sat Jul 14, 2018 7:47 pm

Thanks for the helpful suggestions everyone!

Hillview
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Re: Braces: Keeping cost down and insurance questions.

Post by Hillview » Sun Jul 15, 2018 7:32 am

Ask around for a good orthodontist. Get 2 opinions and 2 estimates (3 if you can). We used FSA funds and our ortho provides a payment plan without any interest. We paid son #2's off entirely with the FSA and son #1's with some of the FSA and the rest is on a payment plan of 180 a month for a year. Our kids don't need weekly checks but some kids around us at same ortho do need weekly checks so it does vary. Good luck!

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Re: Braces: Keeping cost down and insurance questions.

Post by grabiner » Sun Jul 15, 2018 9:39 am

Tanman4223 wrote:
Sat Jul 14, 2018 4:32 pm
If you do not have a HDHP for your insurance, I would suggest checking to see if your employer offers a healthcare FSA.
Even if you do have a HDHP, check whether you have a limited-purpose FSA, usable for only dental and vision; this would allow you to put in $2500 towards braces or other dental costs tax-free, and keep the HSA for other current or future medical expenses.
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fortfun
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Re: Braces: Keeping cost down and insurance questions.

Post by fortfun » Mon Jul 16, 2018 8:57 am

grabiner wrote:
Sun Jul 15, 2018 9:39 am
Tanman4223 wrote:
Sat Jul 14, 2018 4:32 pm
If you do not have a HDHP for your insurance, I would suggest checking to see if your employer offers a healthcare FSA.
Even if you do have a HDHP, check whether you have a limited-purpose FSA, usable for only dental and vision; this would allow you to put in $2500 towards braces or other dental costs tax-free, and keep the HSA for other current or future medical expenses.
Thanks Grabiner. Neither of our insurances indicates anything about a limited-purpose FSA, they only mention FSA. We are on a HDHP plan (HSA). Is there any way to get our employers to offer a limited use FSA?
Thanks!
Fortfun

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grabiner
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Re: Braces: Keeping cost down and insurance questions.

Post by grabiner » Mon Jul 16, 2018 7:46 pm

fortfun wrote:
Mon Jul 16, 2018 8:57 am
grabiner wrote:
Sun Jul 15, 2018 9:39 am
Tanman4223 wrote:
Sat Jul 14, 2018 4:32 pm
If you do not have a HDHP for your insurance, I would suggest checking to see if your employer offers a healthcare FSA.
Even if you do have a HDHP, check whether you have a limited-purpose FSA, usable for only dental and vision; this would allow you to put in $2500 towards braces or other dental costs tax-free, and keep the HSA for other current or future medical expenses.
Thanks Grabiner. Neither of our insurances indicates anything about a limited-purpose FSA, they only mention FSA. We are on a HDHP plan (HSA). Is there any way to get our employers to offer a limited use FSA?
Thanks!
Fortfun
You have to ask your employer; there is some extra administrative work to set it up. The benefit isn't usually that great since you can't anticipate that much in medical and dental expenses. (However, it is possible to take advantage of this as you are planning to do, and I have also done this, opening an FSA in December because I knew I would have dental work done in January or February of the next year.)
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fortfun
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Re: Braces: Keeping cost down and insurance questions.

Post by fortfun » Mon Jul 16, 2018 7:59 pm

grabiner wrote:
Mon Jul 16, 2018 7:46 pm
fortfun wrote:
Mon Jul 16, 2018 8:57 am
grabiner wrote:
Sun Jul 15, 2018 9:39 am
Tanman4223 wrote:
Sat Jul 14, 2018 4:32 pm
If you do not have a HDHP for your insurance, I would suggest checking to see if your employer offers a healthcare FSA.
Even if you do have a HDHP, check whether you have a limited-purpose FSA, usable for only dental and vision; this would allow you to put in $2500 towards braces or other dental costs tax-free, and keep the HSA for other current or future medical expenses.
Thanks Grabiner. Neither of our insurances indicates anything about a limited-purpose FSA, they only mention FSA. We are on a HDHP plan (HSA). Is there any way to get our employers to offer a limited use FSA?
Thanks!
Fortfun
You have to ask your employer; there is some extra administrative work to set it up. The benefit isn't usually that great since you can't anticipate that much in medical and dental expenses. (However, it is possible to take advantage of this as you are planning to do, and I have also done this, opening an FSA in December because I knew I would have dental work done in January or February of the next year.)
Sadly, neither of our employers offers, or plans to offer in the future... You would think a University that is pushing the HDHP HSA plan would offer such a plan....

Itorian
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Re: Braces: Keeping cost down and insurance questions.

Post by Itorian » Fri Aug 17, 2018 12:23 am

I read everything and still confused where to go.
I'm in the DOD so I have FEDVIP, TSP, etc.

However, currently no insurance & 2 kids need braces.
Have to decide which dental insurance to go for. Advice?

SheReadsHere719
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Re: Braces: Keeping cost down and insurance questions.

Post by SheReadsHere719 » Fri Aug 17, 2018 2:58 pm

*Agree with Determined about using an HSA and/or limited FSA to pay for services pre-tax, plus the credit card points and paid-in-full discount

*Both Determined and EHEngineer are correct about primary and secondary; this is referred to as Coordination of Benefits. Per the ADA, the determination of which plan is primary vs. which plan is secondary for Dependent Children is as follows: “The typical rules for dependents of parents with overlapping coverage rely on the birthday rule, that is, the parent with the earliest birthday in a calendar year is primary. In the case of divorced/ separated parents, the court's decree would take precedence.”
http://ada.org/coordination

*As EHEngineer outlined, the orthodontist’s office would need to submit the claims to the primary insurance up to the max, then receive a $0 payment for claims after the max, and send the EOB + claim to the secondary insurance for reimbursement. This could be a cost savings, but would require close billing management on your part

*A key feature of dental insurance is the Annual Maximum. My recommendation is to time the braces with the Annual Max. Example with 1.5 years of treatment and a $2,000 annual max:

Begin braces Q4 2018, use up 2018 max
Braces for duration of 2019 <- this is when you should consider dual coverage and/or HSA/FSA funds
Finish braces in Q1 2020 and use up $2,000 max

This will obviously vary by duration of treatment, but that is the best way to leverage dental plan rules.

Itorian: as such, make sure to pay close attention to the Annual Max for the plan you select.

HereToLearn
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Re: Braces: Keeping cost down and insurance questions.

Post by HereToLearn » Fri Aug 17, 2018 3:12 pm

SheReadsHere719 wrote:
Fri Aug 17, 2018 2:58 pm
*Agree with Determined about using an HSA and/or limited FSA to pay for services pre-tax, plus the credit card points and paid-in-full discount

*Both Determined and EHEngineer are correct about primary and secondary; this is referred to as Coordination of Benefits. Per the ADA, the determination of which plan is primary vs. which plan is secondary for Dependent Children is as follows: “The typical rules for dependents of parents with overlapping coverage rely on the birthday rule, that is, the parent with the earliest birthday in a calendar year is primary. In the case of divorced/ separated parents, the court's decree would take precedence.”
http://ada.org/coordination

*As EHEngineer outlined, the orthodontist’s office would need to submit the claims to the primary insurance up to the max, then receive a $0 payment for claims after the max, and send the EOB + claim to the secondary insurance for reimbursement. This could be a cost savings, but would require close billing management on your part

*A key feature of dental insurance is the Annual Maximum. My recommendation is to time the braces with the Annual Max. Example with 1.5 years of treatment and a $2,000 annual max:

Begin braces Q4 2018, use up 2018 max
Braces for duration of 2019 <- this is when you should consider dual coverage and/or HSA/FSA funds
Finish braces in Q1 2020 and use up $2,000 max

This will obviously vary by duration of treatment, but that is the best way to leverage dental plan rules.

Itorian: as such, make sure to pay close attention to the Annual Max for the plan you select.
Traditional dental insurance has an annual max but ortho coverage is almost always written as lifetime max, so for the purposes of dental insurance reimbursement, it does not matter how many calendar years are spanned. Different for HSA plan reimbursement.

BeneIRA
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Re: Braces: Keeping cost down and insurance questions.

Post by BeneIRA » Sat Aug 18, 2018 6:38 am

Ortho is written in dental plans as a separate lifetime maximum, so to make it simple, you could start orthodontist services late in the year, say November, and make sure your child is covered on one insurance plan. Submit the full amount, I am sure the ortho will be more than happy to bill it, meet that maximum. Then, for Annual Enrollment, flip to the Spouse's dental insurance company, they need to be a different company, effective 1-1-2019, then for plan year 2019, submit the lifetime maximum for that plan. Voila, you have probably gotten $3,000 worth of an ortho benefit without having to deal with coordination of benefits with multiple insurance companies.

rkhusky
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Re: Braces: Keeping cost down and insurance questions.

Post by rkhusky » Sat Aug 18, 2018 8:44 am

Our dental plan required you to be enrolled for 1 year before billing for orthodontics and it a had a lifetime cap. The insurance company also required a written plan from the orthodontist and then set up their own payment schedule that was different than the billing from the orthodontist. We paid the orthodontist on his schedule and the insurance company reimbursed us on their schedule, which spread the lifetime cap over the whole treatment schedule (2 years). It seems like switching insurance companies mid-stream would be problematic. The combination of the insurance and regular FSA tax savings dropped the cost to less than half.

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gasdoc
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Re: Braces: Keeping cost down and insurance questions.

Post by gasdoc » Sat Aug 18, 2018 9:00 am

In our area, the new Smiles Direct is half the price of Invisalign which, when our daughter went through Invisalign, was roughly the same price as braces. There is an adult colleague using Smiles Direct that seems satisfied with the system.

Gasdoc

Determined
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Re: Braces: Keeping cost down and insurance questions.

Post by Determined » Sat Aug 18, 2018 9:19 am

My son had his consultation this week. We only have one insurance plan, so trying to get lifetime maximum out of two doesn't apply. Here's how this one bteaks down.

Cost of orthodontics. $3800
Expected insurance adjustment - $1800
Discount for paying upfront. -$500
Total $1500

I will elect $1500 into a limited FSA during enrollment in October. Braces go on in early January. I will pay with a credit card and submit for reimbursement. I will also contact my ex for his portion non-customary medical expenses which could bring my total down to $1000, but I am not holding my breath 😀

nolesrule
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Re: Braces: Keeping cost down and insurance questions.

Post by nolesrule » Sat Aug 18, 2018 12:36 pm

This post inspired me to check, and sure enough my wife's employer offers a Limited Purpose FSA.

The kids are getting braces on Monday... we have a timing issue with one of them in that we'd like her to be done by the time she turns 13. The other one could wait, but she got my teeth, and she wants to get started sooner rather than later, and I don't blame her, as I know how she feels about her teeth as they are now.

Financially, with the LPFSA we'd be a little better off waiting until January 2019 to start, but ultimately it's not the end of the world.

The breakeven point on the payment plan with LFPSA vs. the up-front discount is September 2019, and ultimately we'll save about $750 more by going with the LPFSA.

SheReadsHere719
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Re: Braces: Keeping cost down and insurance questions.

Post by SheReadsHere719 » Wed Aug 22, 2018 4:17 pm

BeneIRA wrote:
Sat Aug 18, 2018 6:38 am
Ortho is written in dental plans as a separate lifetime maximum, so to make it simple, you could start orthodontist services late in the year, say November, and make sure your child is covered on one insurance plan. Submit the full amount, I am sure the ortho will be more than happy to bill it, meet that maximum. Then, for Annual Enrollment, flip to the Spouse's dental insurance company, they need to be a different company, effective 1-1-2019, then for plan year 2019, submit the lifetime maximum for that plan. Voila, you have probably gotten $3,000 worth of an ortho benefit without having to deal with coordination of benefits with multiple insurance companies.
Thank you for clarifying! I like this approach.

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