Tricare dental patients will see some improvements in their benefits when a new contract takes effect May 1, but some families have expressed concerns over their dentists dropping out of the network, reportedly because of lower reimbursement rates..
An official for the incoming contractor, United Concordia, said families having trouble finding an in-network dentist can call the contractor for assistance, including help scheduling an appointment, at 844-653-4061 (outside the continental U.S., dial 844-653-4060).
The new contractor is exceeding its obligations when it comes to providing access to care, a Tricare official said.
Beneficiaries enrolled in the Tricare Dental Program don't need to take any action to continue their coverage, according to Tricare officials, but you should check to make sure your dentist remains in the network. Otherwise, you could be paying more out of pocket for dental care.
This is a voluntary dental benefit for eligible active-duty family members, National Guard and Reserve members, and their families. No changes are set for the Active Duty Dental Program or the Tricare Retiree Dental Program.
The monthly premium decreases range from $0.58 to $16.84. The largest decrease is for the monthly premium cost for sponsor and family coverage for a service member in the Individual Ready Reserve who is not mobilized.
Other improvements set for May 1, when United Concordia takes over for MetLife, include:
- Increasing the annual maximum dental benefit Tricare will pay, from $1,300 to $1,500 -- $200 more in benefits per person.
- Eliminating out-of-pocket costs for sealants, which will be considered a free and preventive treatment for families, and no longer requiring families to pay 20 percent of the cost.
- Lowering the auto-enrollment age for family members lowers from age 4 to age 1. "This enables preventive technicians to educate parents at an earlier time in the child’s development," said Army Col. James Honey, a dentist who is chief of the Tricare dental care section.
- Tailoring the benefits for patients with chronic conditions, as well as creating a special needs program and a pregnancy benefit.
DENTISTS DROPPING OUT?
Some families claim they'll need to find new providers to take advantage of those new benefits, telling the National Military Family Association that their dentist has informed them they will drop out of the Tricare dental network as of May 1, when United Concordia takes over.
If the family stays with that non-network dentist, they'll pay more out of pocket. In these cases, families could be billed for the full cost of the dental visit, and they may have to file their own claims, according to Tricare Dental Program officials. They'll be responsible for paying the difference between United Concordia's allowed fee and the amount charged by the non-network dentist – in addition to the applicable cost-share percentage.
Otherwise, families would have to find a new dentist in the network. Dentists in the network have signed a contract with United Concordia.
"I hate having to seek out a new dentist when we aren't even PCSing," stated one military wife, commenting on the NMFA website.
Another wife commented that if she stays with her current dentist after that dentist leaves the network, she''ll have to pay more than $80 out of pocket for a cleaning and checkup ... for her and each of her two kids.
"Sure it looks great that they are giving us a few things, but if you can't find a dentist that will even take the insurance, where does that leave you?" she said.
United Concordia is meeting – and exceeding -- the contract requirements for having enough dentists to ensure that military families have access to dental care, Honey said.
"It's essentially the same program, and we're still as stringent with access," he said, adding that officials are "primed for this to be a smooth transition."
The contract with the Defense Department requires that 95 percent of Tricare Dental Plan enrollees have access to a general dentist within the network that's within 35 miles of their location and can provide a non-emergency appointment within 21 days.
"As of April 1, 98 percent of TDP enrollees have access to a general dentist within less than 20 miles of their residence," said Sharon Duke, director of government affairs for the government business unit at United Concordia Companies Inc.
United Concordia declined to provide information about the number of dentists in their network, or how many dentists have left the Tricare Dental network, citing proprietary reasons. Duke said anyone enrolled in the Tricare Dental Plan who has trouble finding a network dentist can call United Concordia for immediate assistance. Families can also visit the contractor's website for further contact information.
The company is not new to Tricare, having administered the Tricare Dental Plan contract from 1996 to 2012 and administering the Tricare Active Duty Dental Program since 2008. Active-duty members get most of their dental care at military dental clinics, but if they need to get dental care from a civilian dentist, they use that Tricare program.
"If there are any bumps in the road, there are contractual mechanisms to ensure the beneficiary retains robust access" to dental care, Honey said. For example, the contractor might bear the cost of a patient seeing a dentist who is not in the network if there aren't enough local network dentists, or the contractor may go back to renegotiate the reimbursement to dentists in that area.
Honey said he has gleaned that in some local areas, the reimbursement rates may not be as high as they were with the previous contractor. The government doesn't control or set rates for reimbursement, and doesn't specify guidance.
"We purchase access and enforce the access" to care, he said. "We will closely monitor this and ensure beneficiaries have access."
Karen Jowers covers military families, quality of life and consumer issues for Military Times. She can be reached at email@example.com.