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Get the most out of your dental benefits

TRICARE Dental and United Concordia - what you don’t know can’t benefit you

Knowing your benefits goes a long way in saving your money.

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If you ask the average TRICARE Dental Program (TDP) beneficiary who their dental insurance carrier is many of them will reply "TRICARE." The correct answer is United Concordia.

The carrier is not the only thing that people do not know about their dental insurance. There are dozens of misconceptions that leave beneficiaries confused, left with large dental bills and in some cases, a reluctance to use their dental benefits. 

The good news is that there are several things that you can do to make sure that you receive the benefits that you are entitled to, without having to take out a second mortgage to pay hefty dental bills.

First, know your benefit, Sharon Duke, the Director of Marketing & Outreach for Department of Defense (DoD) Programs for United Concordia, said.  Know your annual maximum and your cost share rates, she said.  There are cost - shares for members both CONUS (within the continental United States) and now OCONUS, (overseas), she said. Although in previous years dental services were covered at a 100 percent rate for soldiers and their family members stationed OCONUS, this is happening less frequently now due to high deployments.

"It used to be that family member dental treatment was, for the most part, provided in military dental facililties," she said. "Now with so many deployments and other requirements, many overseas military dentists are spending a majority of their time treating active duty service members.  As a result more dental work is being done in the private sector for family members."

How much you pay out-of-pocket is dependent upon your sponsor's pay grade.  Your cost ranges anywhere from 0 to 50 percent of the total bill. (See the sidebar for cost-share rates).

When in doubt, get a predetermination - a written statement of your cost share - for dental services with a higher cost such as bridges or implants, she said. 

Predeterminations let both you and the dentist know if the services are covered and the anticipated amount of payment, prior to receipt of care.

Enroll in TRICARE Dental before you leave an overseas tour, for a CONUS one, she said. 

Many people think that if they are enrolled in TRICARE Medical they are enrolled in the TRICARE Dental Program." They are not. Sponsors must enroll their family members.  They can do this online at www.TRICAREdentalprogram.com."

Also understand that when you enroll you are obligated for one year, she said.  This is crucial for Reserve or National Guard members who enroll their families when they are activated.

"When a reserve or guard member is activated they often enroll their family members in the TRICARE Dental Program at the active duty family member premium rate," Duke said.

"Then when they are deactivated they must pay the full premium for the remainder of a 12-month TDP enrollment obligation, which is substantially higher. They need to understand this before they enroll."

Third, know who is eligible for coverage under your family plan. Your fiancé, girlfriend, or parents are not eligible even if they reside with you.  (See the benefit booklet at www.tricaredentalprogram.com for specific information).

Fourth, know what is covered prior to agreeing to any dental treatment.  The following items are covered:

  • Diagnostic and preventive services (exams, cleanings, fluoride treatments, sealants and X-rays)
  • Restorative services (fillings)
  • Endodontics (root canals)
  • Periodontics (gum and bone dental services)
  • Oral surgery (extractions, biopsies and other surgeries)
  • Prosthodontics (crowns, bridges and dentures)
  • Orthodontics (braces)
  • Implants

However, be very careful when you go to the dentist.  Make sure that you clearly understand how much you will owe when the services are completed. Do not allow the dentist to perform any work without a quote for dental fees due.  Sometimes the difference in services is very small, but the cost can be significantly higher.

At the Orthodontic and Pediatric Dental Specialists they always divulge any costs for treatment before any dental work is performed, Heather Joyce, the scheduling coordinator in the Tacoma-based office said.

"We have so many military patients in our office that we know what United Concordia will and will not cover," she said. "So we can tell our patient's exactly what the cost to them will be before any services are performed."

Another issue is services that are covered under the TDP.  One example is fillings, she said.

"The TRICARE Dental Plan only covers the silver fillings and we only do white fillings," she said. "The patients have to pay the difference between the cost of the silver filling and the white filling and this can be a substantial cost."

Fifth, find a participating dentist.  This is a dentist who has signed a contractual agreement with United Concordia to follow TDP rules for providing care and accepting payments. Participating dentists agree to:

  • Accept United Concordia's allowance for covered services as payment in full.
  • Accept direct payment from United Concordia for covered services.
  • Complete the claim form at no extra charge and submit it to United Concordia.  
  • Participate in United Concordia's quality assurance programs.
  • Submit predetermination requests.
  • Provide any information needed by United Concordia to make coverage and payment determinations.  

The bottom line is to make sure that you find a TDP participating dentist, not just a dentist who accepts United Concordia.  Most dentists will accept payment from United Concordia, but this does not mean that they are a participating dentist.

To find a participating dentist, visit the TDP Web site at www.TRICAREdentalprogram.com and click on "Information for Enrollees," then "Find a Dentist" under the "Quick Links" tab.  Then search for a dentist by last name, specialty, city, county or ZIP code, or you can call 1-800-866-8499 and speak to a customer service representative.

United Concordia started a Facebook page last week.  To visit the page and learn more about TRICARE Dental Program visit the site at: www.facebook.com/TDP.ADDP.

For tips on choosing the right dentist as well as a list of local TRICARE participating dentists visit www.northwestmilitary.com.

Comments for "Get the most out of your dental benefits" (2)

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Ret MSG said on Aug. 07, 2010 at 8:40pm

OK just need some guidance.

I signed up for this ins Friday, I have 30 days to decide to keep it the year or reject before I'm obligated to do the full year.

I still have some reservations. After looking over the copays, and deductible, and the 1200 limit per year,( actually 1150.00 after the 50.00 deductible too) I'm wondering weather this is still worth while.

My dentist (Ellis in Hopewell) gave me what he considers I need after looking at xrays. I will need what amounts 2338.00 now I see where I would be covered now for the perio work at 956.00 at 60% but not the crown at 1253.00 which would be at 50%. and not until my 1st year in the plan.

So now if I pay 66.00 for 12 months = 792.00,

The perio is 956 @ 60%=573.60 leaving me with 382.40

382.40 plus my 50.00 deductible =432.40 my part,

432.40 plus my years premium =1224.40

1224.40 less the total fee of 956 = 268.40 more I'd be paying with this plan.

With the crown it would be even more of a difference.

So explain to me just what exactly iis my advantage in keeping this insurance? opposed to just paying out of pocket? I'm asking because I thought having insurance was to "save " me money?

I would post my email but I don't think you would al;low that to respond back to me. that way. But I think you can get it from the post info.

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Laura said on Jan. 11, 2011 at 2:41pm

I don't quite understand where you got $66 a month for the insurance from. Ours is 31.72 for me and two children a month, excluding the active duty member, who get it free from the dental clinic.
We have probably paid more in premiums this year than the services I got. I am the only going this year and I am getting some bad cavities filled that I couldn't while pregnant.
However, we pay for both of our kids, 2 and 1, because of the unforeseen. For instance, when we first bought our house, our then 18 month old took a dive towards a concrete step. Broke her pacifier in half, but didn't hurt a tooth. If that pacifier wasn't there we would've paid all of those dental bills out of pocket. Because of that close call, we carry the insurance on them and take them for regular cleanings.
Dental/ Health/ Car insurance is all of the same. You get it hoping you won't use it. I have used $900 of my $1200 this year. A total cost of $1500 to tri-care because cleanings and x-rays don't come out of the max and we don't pay for preventative services. I too needed a crown (thank God no root canal) and have had three fillings done a cost of $1100. We paid out of $380.64 in premiums, so the insurance has saved us a little over $1,100 minus our premiums paid.

If you need a lot of work done, I would recommend to split it over multiple visits. Originally I was told I needed $3,000 of work done (lots of cavities and a crown). I decided to break it down and split it over two plan years. Right now I am due to go in one more time to get two more cavities done that would bring my plan to near zero. Instead of paying the last one out of pocket (for $244), I am waiting until the plan resets on Feb 1 then make an appointment for that. This is the best way I have found to let the insurance work for me.

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