We’re dealing with dental insurance decisions again because I chipped a front tooth and my old Marine needs a tooth capped. We purchased the cheapest VADIP group plan when it was first introduced–the Delta VADIP plan for my husband (non-Champa spouses are excluded) for one year. Then we upgraded to the High Option Metlife which was more liberal.
Neither of our dentists are in-network and mine is really pricey. So we just purchased a secondary policy that will give us in-network rates and co-ordinate benefits with Metlife. The good news is that there is no waiting period for major services because we’ve continuously had dental insurance for over a year. The bad news is that we’ll be paying about $250 a month for the two plans. That’s a crazy figure but our expected 2016 dental out-of-pocket costs would be worse with co-pays and deductibles due at time of service. Ugh!
Looking ahead to 2017, I’m pretty darn sure my spouse falls under the Class VI (LINK to FACT SHEET). Or consult the VETERANS HEALTH ADMINISTRATION DENTAL PROGRAM/VHA HANDBOOK 1130.01 2013.
Class VI. Any Veteran scheduled for admission or who is receiving care under chapter 17 of title 38, U.S.C., may receive outpatient dental care if the dental condition is clinically determined to be complicating the medical condition currently under VA treatment. Eligibility for each episode of dental care will be predicated on referral and consultation, followed by a decision based upon clinical judgment. The goal is to provide focused care to treat only the oral conditions that are complicating impact the clinical management of the medical condition currently under treatment. This classification includes medically necessary dental care for Veterans receiving care for Military Sexual Trauma under Title 38 U.S.C. 1720D.
Last year, my spouse asked his MN VA PCP for a referral to get classified by the Dental Services via Secure Messaging. The doc called him, told him NO, and muttered some BS. We are hoping his new VA PCP (VT) will follow the rules and give a referral so the VA Dental Service Chief can review his medical records, and make a decision. If classified, he’d keep private dental insurance for preventative/filings and use the VA for expensive “focused” services they might approve (see page 10 in Handbook) (b).
…Focused dental treatment is generally limited and may include supportive periodontal therapy, endodontic therapy, restorative dentistry, and oral surgical procedures…
Pre-VA dental classification exam, why not bring a nexus letter and some solid research to the classification exam with you to support how, for example, your dry mouth/oral disease case is related related to your VA meds or conditions. Think of it as a C & P exam. (Looking at some BVA dental claim denials, the dental examiners have a funny habit of not seeing any evidence of dry mouth etc…) If denied an appropriate classification, it might be worth it to file a NOD.
In our case, could my spouse get Non-VA Dental services? Maybe under the new geographic inaccessibility concept mentioned in the Handbook (beginning on page 16 Link below). (The nearest VA Dental Services is about 105 miles away from our house.)
With approval, veterans could see a general dentist of their choice, who accepted VA payments, or be referred to a dentist in a “Federal resource”. It’s not clear if that would include dental care at a Federally Qualified Health Center (LINK) or (LINK hrsa). These centers bill on a sliding scale, receive federal grant money and are good to know about.
NOTES & LINKS:
VA Handbook dental 2013 VA dental 2013 (attachment on 2nd page).
- Any Veteran eligible for dental treatment on a one-time completion basis only and who has not received such treatment within 3 years after filing the application must be presumed to have abandoned the claim for dental treatment. (see Title 38 CFR §17.164)
- SC PTSD–No automatic Class III dental for you. Really? Is this a good idea? Painful teeth wouldn’t directly impact PTSD or vise versa? Class III. “…However, there is no provision granting eligibility for dental care under this classification in case of the opposite relationship, where a medical condition (e.g. Post Traumatic Stress Disorder (PTSD), may be contributing to a dental condition (e.g bruxism) because the dental condition identified is not professionally determined to aggravate the medical condition.” (Bruxism is tooth-grinding.)
- If a non-VA dentist’s fee is over $1,000, trouble ahead.
- Need a non-VA dental specialist? Forget it.
- If a veteran doesn’t accept a treatment plan, (take it or leave it care) they will rue the day.
- The Military Order of the Purple Heart has some VSO training slides online (LINK M-4 Dental Claims) Attachment 2nd page.
- The Business Office decides who is eligible for VA dental care by statute except for classes III and VI which are decided by the Dental Officers after medical record reviews.
A few questions: When and who in our government decided that our teeth and mouth aren’t a part of our bodies? Why have they allowed dental insurance scams to go unchecked?
Why haven’t licensed dental hygienists been able to open their own practices to provide preventative non-VA dental care?
Any veteran out there receiving non-VA dental care? If so, how did you access it?
Why is it that a VA employee can seek dental care by the Dental Service but if a veteran needs emergency care, and isn’t classified, he can expect a bill ($500)? Don’t we buy them their own federal gold-standard dental insurance which they don’t have to jump through hoops to use.