TRICARE Dental change helps children with special needs

"When on staff at the Naval Postgraduate Dental School, National Naval Medical Center (NNMC) Bethesda, Md.," Alexander explained, "I was also specialty leader for Pediatric Dentistry for the Navy." She said during that time it came to her attention that TRICARE did not pay for the general anesthesia or for the facility fee to have the dental work done. "This is a sad disparity because if the same child needs her tonsils out, TRICARE will take care of it out in town," she said.

Alexander pointed out, "A segment of our dependent population, those with severe autism, cerebral palsy, epilepsythese patients really can't be treated for dental disease in your standard dental office. Many of us kept asking the question, 'Why isn't military medicine helping out these kids?' It is very heartbreaking to have military families go to Navy and Marine Corp Relief Society to pay for $4,000 worth of medical bills."

Several organizations had been pushing for changes to fix this prob-lem. And finally, under the National Defense Authorization Act of 2007, the expanded benefit was passed into law.

Alexander indicated that the coverage doesn't cover all the family's expenses associated with such treatment but that it does make a dent in the bill. It basically covers the cost of the same-day-surgery suite and payment for the oral surgeon or pediatric dentist doing the work.

ATRICARE Management Activity release announced in December 2006 that the change in statute does not include the actual dental services covered through the TRICARE Dental Program and the TRICARE Retiree Dental Program. It does, however, enhance the benefit for military families.

To realize savings under the program parents must submit their bills for reimbursement. Specifics on the implementation of the change are still being written into TRICARE Manuals and dental care services contracts.

Naval Hospital Jacksonville Pediatric Dentist Capt. Margaret Alexander performs routine dental care on a special needs patient who required sedation in the operating room.

Larry Coffey, a retired Navy senior chief petty officer and father of Johnathan, a 12-year-old with a seizure disorder, is one parent who says his family will benefit from the change. "My son has seizures. Johnathan wouldn't cooperate in the dental chair which is very typical. If you have seizure potential, they have to put you in the operating room for that. They had to give him general anesthesia just to have cavities filled," he said.

Most states require insurance companies to provide coverage for such dental procedures, but TRICARE, the military health plan, was not covering this care. "I took my son to a hospital in Knoxville, Tenn.," Coffey stated. "We had the dental insurance. I received a $5,000 bill because it was not a covered benefit. They would pay for the dental procedures, but they said general anesthesia is a medical procedure and nobody would cover it."

Coffey first met Alexander in 2005 at NNMC Bethesda, when she treated Johnathan at the military medical facility to save the family the costs of