Northwest Military

Get the most out of your dental benefits

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

By Cassandra A. Fortin on March 17, 2010

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:

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:

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.