Patients will save, some docs will flee TRICARE dental plan
Responsibility to provide dental care coverage to 1.37 million active duty family members, and 376,000 Reserve and Guard members and their families, will shift May 1 from MetLife to United Concordia Companies Inc. of Harrisburg, Pa.
The change in TRICARE Dental Program contractor will bring lower patient premiums and a modest expansion of covered services. However, United Concordia also will lower key reimbursements to dentists below what they have been paid, prompting some dentists to warn patients they won't be joining the new network.
So, starting next month, an unknown number of TRICARE Dental Program enrollees will need to find new dentists off a directory of participating providers that United Concordia began to build after it won the competitive bid contract last year.
TRICARE beneficiaries are accustomed to having to switch health care providers from time to time, usually when they move to new assignments or when TRICARE support contracts expire and a new company wins the business.
With TRICARE Dental, family advocates say they have several concerns. One is whether United Concordia, by lowering some payments to network dentists, will create coverage gaps in some areas. Another worry is that lowered payments could impact the overall quality of the network provider pool.
A third concern is that the Find-a-Dentist directory run by United Concordia lists too many dentists who have decided, or might soon, not to participate.
Karen Ruedisueli, deputy director of government relations for the National Military Family Association, said she used the directory at www.uccitdp.com to find general dentists within 10 miles of the 66027 zip code for Fort Leavenworth, Kan. Of 12 names that popped up, the two nearest said they would not participate. Of the other 10, two in Lansing, the next town over, said they had just switched management and would not be participating. And an office worker for two more dentists in Platte City, still a reasonable drive away, told Ruedisueli that United Concordia is cutting rates so significantly they probably would leave the network.
"United Concordia is making the argument that although families may have to switch providers, they will still have access to dental care," Ruedisueli said. "I would contend, however, that we are seeing a pretty significant shrinking of the network, at least in certain areas, and maybe overall. It's just really early to tell."
Her organization as well as the Military Officers Association of America are hearing complaints about providers advising patients they won't join the network.
Army Col. James R. Honey, chief of TRICARE Dental Care for the Defense Health Agency in Falls Church, Va., said in a phone interview April 17, and through follow-up emails, that any concern about coverage gaps and the accuracy of United Concordia's Find a Dentist directory are unfounded.
As with MetLife, he said, United Concordia will be required to meet Code of Federal Regulation standards that 95 percent of enrollees have access to care within 35 miles of their homes and within 21 days. Honey is confident that, also like MetLife, United Concordia will have a network big enough to surpass the targets and that 98 percent of enrollees can access quality dental care within 20 miles of home.
Honey has heard from dental groups citing lower reimbursement rates for not participating in the network. He is not alarmed, he said, because United Concordia still has been signing many dental care providers. With any change in contractor, he said, there will be dentists "who opt out and some who join. But I believe we will not have any problem with access. The net number of providers per area will remain close to, if not above, 98 percent" coverage within 20 miles to beneficiaries.
TRICARE doesn't dictate what providers are reimbursed, Honey said. That's for the vendor to negotiate. But if United Concordia fails to build an adequate network in an area, it can be ruled non-compliant with the contract. It would be forced to renegotiate rates to ensure proper coverage or beneficiaries could use non-network providers and the contractor would have "to eat" added costs, he said.
"So either way, the beneficiary is still taken care of," Honey said. "We'll not only monitor the access as it occurs, but we'll also ensure that there isn't any beneficiary who doesn't have robust access" to dental care.
Honey also is confident beneficiaries won't see quality of care slide, he said, "because access standards are still very stringent. In the larger practice of dentistry, I wouldn't presume that those who wish to be in that 98 percent would be inferior in any way, particularly with state licensure, peer review and all the requirements a dentist practicing in the United States has to follow."
He emphasized the directory of participating dentists is accurate. A spokesman later noted that for Fort Leavenworth the Find a Dentist directory lists 147 general dentists in the network within 25 miles of the post. Beneficiaries don't need to take any action to continue coverage unless their dentists haven't joined the network Then they will have to find one using the Find-a-Dentist directory.
Beneficiaries also can learn how premiums will fall using an online chart at: https://tricare.mil/Costs/DentalCosts/TDP/Premiums. The size of the drop ranges from a half dollar a month for single active duty family members to more than $16 a month for a reservist with family coverage. Other plan improvements are:
nAn increase in the annual maximum TRICARE will pay for dental care under the plan, from $1,300 to a new ceiling of $1,500.
nSealants at no charge as preventive treatment to protect permanent teeth after eruption. A current requirement that beneficiaries pay a 20-percent cost share for sealants will end.
nAuto-enrolling children of families at age 1 rather than age 4. The goal is to educate families sooner on proper dental health, and particularly to discourage the practice of keeping children on nursing bottles too long and allowing sugared drinks that can cause rapid decay of newly erupting teeth.
"The idea here is to get at the educational part with parents early so they understand this problem and can completely mitigate it by keeping track of time with the bottle and what actually is in the bottle," Honey said.
The contract awarded to United Concordia could total $1.6 billion, assuming it exercises all five one-year option periods. TRICARE Dental Program is a voluntary plan for family members of active duty personnel and of Guard and Reserve members. Guard and Reserve members are eligible too when not on active duty or covered by TAMP, the Transitional Assistance Management Program.
Delta Dental administers a separate TRICARE Retiree Dental Program, which is unaffected by this contract. The Defense Health Agency would like to see higher participation in the TRICARE Dental Program, particularly from reserve components. Only 14 percent of Selected Reserve and National Guard members have enrolled.