United Concordia Tricare is a dental insurance plan that provides coverage for military members and their families. Dental implants are an increasingly popular option for replacing missing teeth. If you are a Tricare beneficiary and are considering dental implants, it's important to understand if your insurance plan will cover the costs. In this article, we will discuss 10 important aspects of United Concordia Tricare coverage for dental implants.
1. Coverage Eligibility
Before diving into the specifics of coverage, it's crucial to determine if dental implants are covered under United Concordia Tricare. In general, Tricare provides coverage for dental implants; however, specific guidelines and conditions may apply.
1.1 Active Duty Service Members - Dental implants may be covered if deemed medically necessary due to trauma or medical conditions that result in loss of teeth.
1.2 Family Members of Active Duty Service Members - The coverage criteria are similar to that of active duty members.
1.3 Retired Service Members - Dental implants may be covered if a personal injury resulted in tooth loss during active duty service.
1.4 National Guard and Reserve Members - Coverage for dental implants is available under the Tricare Dental Program, which is administered by United Concordia Tricare.
2. Pre-authorization Process
Prior to undergoing a dental implant procedure, it is important to obtain pre-authorization from United Concordia Tricare. Typically, your dentist or oral surgeon will submit a treatment plan, including cost estimates, to the insurance company for review. The pre-authorization process ensures that the treatment meets the necessary criteria for coverage.
2.1 Required Documentation - Your dentist may need to submit X-rays, photographs, and detailed treatment plans to support the pre-authorization request.
2.2 Waiting Period - There may be a waiting period of up to six months for non-urgent dental implants. However, immediate implant placement following tooth extraction may be considered urgent and not subject to the waiting period.
3. Coverage Types
United Concordia Tricare offers different dental plans, each with its own coverage levels. The coverage for dental implants may vary depending on the specific plan you have. Here are the three main coverage types:
3.1 Tricare Active Duty Dental Program - This dental program provides coverage for active duty service members.
3.2 Tricare Dental Program - This program is available to family members of active duty service members, National Guard and Reserve members, and retired service members and their families.
3.3 Tricare Retiree Dental Program - This program is available to retired service members and their families.
4. In-Network and Out-of-Network Dentists
United Concordia Tricare has a network of dentists who have agreed to provide services at negotiated rates. Visiting an in-network dentist can help minimize out-of-pocket costs.
4.1 In-Network Dentists - By visiting an in-network dentist, you can benefit from reduced fees for services as well as direct billing to United Concordia Tricare.
4.2 Out-of-Network Dentists - If you choose to visit an out-of-network dentist, coverage may still be available, but at a lower reimbursement rate, and you may need to pay more upfront.
5. Coverage Limitations
While United Concordia Tricare provides coverage for dental implants, there may be certain limitations and restrictions to consider:
5.1 Maximum Benefit - Tricare Dental Program has an annual maximum benefit limit, which may impact the total coverage for dental implants.
5.2 Waiting Period - As mentioned earlier, a waiting period may apply before certain dental implant treatments are covered.
5.3 Medically Necessary Criteria - Dental implants must be deemed medically necessary based on documented trauma or specific dental conditions.
5.4 Age Limitations - Some plans may have age restrictions for coverage of dental implants.
6. Average Cost of Dental Implants with United Concordia Tricare
The cost of dental implants can vary based on various factors, such as the number of implants needed and additional treatments required. On average, a single dental implant can cost between $3,000 to $4,500. However, it's important to note that the cost can vary significantly depending on the specific case and location.
7. Required Diagnostic Procedures
Prior to undergoing a dental implant procedure, diagnostic procedures may be necessary to determine your eligibility and treatment plan:
7.1 X-Rays - X-rays help assess the condition of your jawbone and identify any potential issues that need to be addressed before implant surgery.
7.2 CT Scan - A CT scan provides a detailed 3D image of your jawbone, allowing for precise implant placement planning.
7.3 Impressions - Impressions of your teeth and gums may be taken to create models for precise implant placement.
8. Additional Procedures and Costs
In some cases, additional procedures may be required before or during the dental implant process. These procedures may include:
8.1 Bone Grafting - If your jawbone lacks the necessary density or volume, a bone graft may be required to ensure successful implant placement. The cost of bone grafting can range from $200 to $1,200 per graft.
8.2 Sinus Lift - A sinus lift may be necessary if the upper jaw lacks sufficient bone height to support implants. The cost of a sinus lift procedure can range from $1,500 to $3,000 per side.
8.3 Post-Implant Restoration - After the implant placement, additional costs may be incurred for the restoration, such as abutments and crowns, which can range from $500 to $3,000 per tooth.
9. Claim Process
If you choose to proceed with dental implant treatment covered by United Concordia Tricare, it's important to understand the claim process:
9.1 Direct Billing - In-network dentists will typically submit claims directly to United Concordia Tricare on your behalf, reducing your paperwork and upfront costs.
9.2 Reimbursement - If you visit an out-of-network dentist, you may need to pay for the treatment upfront and then submit a claim for reimbursement.
10. Frequently Asked Questions
10.1 Can dental implants be covered for cosmetic reasons?
No, dental implants are typically covered only when deemed medically necessary due to trauma or specific dental conditions.
10.2 What other alternatives are covered by United Concordia Tricare?
United Concordia Tricare may provide coverage for alternative treatments such as dental bridges or dentures.
10.3 Can dental implants be covered for children and teenagers?
Coverage for dental implants in children and teenagers is limited and usually reserved for extreme cases where tooth loss affects their overall health and development.
References:
- Tricare Dental Program
- United Concordia Tricare Dental Program
- The Economics of Dental Implants
