Posted on Oct 26, 2023
How does a 100% disabled veteran get community care dental benefits?
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I have tried to get benefits for dental care and have been shuffled from provider to provider with nothing being done
Posted 2 y ago
Responses: 15
Community care will (unless grandfathered) generally depend on availability or services at the VA, time/distance you are away from the VA dental clinic, and/or the timeframe for being scheduled for services.
The first step is to have an initial exam by the VA dental clinic*. You can request that you receive future care at a community care provider if you meet one of the eligibility criteria*.
If you meet the eligibility based on travel time, then you should have no problem getting future care from a local provider. Other eligibility may be situational (i.e., "yes" for this treatment/procedure, but we'll have to evaluate for future needs).
One item of note - Community Care providers will have to get pre-authorization for everything. Most will "stack" requests up front (for example, an authorization request for a year's worth of exams, cleanings, etc.), especially if your VA facility's community care office takes a while to send an approval back.
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* Facility search - https://www.va.gov/find-locations/
* Community Care Eligibility - https://www.va.gov/COMMUNITYCARE/programs/veterans/General_Care.asp.
The first step is to have an initial exam by the VA dental clinic*. You can request that you receive future care at a community care provider if you meet one of the eligibility criteria*.
If you meet the eligibility based on travel time, then you should have no problem getting future care from a local provider. Other eligibility may be situational (i.e., "yes" for this treatment/procedure, but we'll have to evaluate for future needs).
One item of note - Community Care providers will have to get pre-authorization for everything. Most will "stack" requests up front (for example, an authorization request for a year's worth of exams, cleanings, etc.), especially if your VA facility's community care office takes a while to send an approval back.
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* Facility search - https://www.va.gov/find-locations/
* Community Care Eligibility - https://www.va.gov/COMMUNITYCARE/programs/veterans/General_Care.asp.
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COL Randall Cudworth
SFC Jo Ann Klawitter - what issue did you contact the advocate about that they could not help you with?
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SFC Jo Ann Klawitter
COL Randall Cudworth maybe it was that email I got from the VA that I thought was a scam, but it wasn’t they were not caught up and it was about my disability claim which was denied
Or maybe it was about getting help financially for my oral surgeries
Right now I’m on the phone with the VA and I was on for a half an hour and then the guy transferred me to somebody else and I waited another half an hour and hung up and their system of leaving your telephone number and they will call you back was not working
Or maybe it was about getting help financially for my oral surgeries
Right now I’m on the phone with the VA and I was on for a half an hour and then the guy transferred me to somebody else and I waited another half an hour and hung up and their system of leaving your telephone number and they will call you back was not working
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SFC Jo Ann Klawitter
COL Randall Cudworth I will ask you about the question I wanted answered maybe you will be quicker
Since the hospital billed the VA for $45,000 or more but the VA only paid around $10,000. Does this mean the public is getting ripped off we all know hospitals overcharge and I was trying to find a way that I could help.
Since the hospital billed the VA for $45,000 or more but the VA only paid around $10,000. Does this mean the public is getting ripped off we all know hospitals overcharge and I was trying to find a way that I could help.
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COL Randall Cudworth
SFC Jo Ann Klawitter - The amount charged by a healthcare provider (individual, office, hospital, etc) to insurance (or a 'reimburser' in this case) is often much higher than the reimbursed rate (just look at any Explanation of Benefits (EOB) that you receive from the VA for a community care visit).
However, the public isn't being ripped off and there's not much you can do to help (well, you could get more involved in the price transparency movements/campaigns
The actual reimbursement rate a provider receives depends on agreements between the two entities. But WHY does the hospital charge a much higher rate than they know they'll receive is something that is a mixture of speculation and 'reports by insiders' (just search for "why do providers charge a lot more than they are reimbursed?").
However, the public isn't being ripped off and there's not much you can do to help (well, you could get more involved in the price transparency movements/campaigns
The actual reimbursement rate a provider receives depends on agreements between the two entities. But WHY does the hospital charge a much higher rate than they know they'll receive is something that is a mixture of speculation and 'reports by insiders' (just search for "why do providers charge a lot more than they are reimbursed?").
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This is all BS the dental care thur VA is a joke this needs to be looked into it should be "no dental care "
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PFC Kay Armstrong
I agree!!!! I'm 100% VA disabled and now 68 years of age. I have NEVER been able to see a VA Dentist. NEVER!!!
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Suspended Profile
I agree with you. I tried to get care (gosh make sure you're 100% disabled) for a broken crown that I almost choked on as it broke when I was eating. First I'm told there's no appts and to use the walk in triage at 12n. Fill out papers, wait, go in only to be told I can't be seen right away. They take X-rays only of the tooth involved instead of doing a panarex (whole mouth). Then if you're lucky you get an appt months away. You don't get any community referral whatsoever- this policy is constantly violated.
I recently saw a building in Knoxville, TN that had a large sign: VA Dental Clinic. I asked about that. I'm informed that the VA has a hiring freeze on. So why have an empty building that you're paying utilities on, as well as other expenses, when it isn't used or isn't staffed? The insanity boggles the mind. Same with Podiatry- have to be 100% disabled to be seen. Finally get 100% rating (after 4 attempts.and 30+ years) and then told its difficult to get into nail care clinic. The VA is responsible for my debility for delaying my spine surgery to where I can't bend and I have neuropathy in both legs. No community care referral here either. Told I don't qualify to be seen in the spine clinic but can't get specifics on criteria to be seen. Once again, no community referral over and over and over again. Two White House Hotline complaints and no improvement
I recently saw a building in Knoxville, TN that had a large sign: VA Dental Clinic. I asked about that. I'm informed that the VA has a hiring freeze on. So why have an empty building that you're paying utilities on, as well as other expenses, when it isn't used or isn't staffed? The insanity boggles the mind. Same with Podiatry- have to be 100% disabled to be seen. Finally get 100% rating (after 4 attempts.and 30+ years) and then told its difficult to get into nail care clinic. The VA is responsible for my debility for delaying my spine surgery to where I can't bend and I have neuropathy in both legs. No community care referral here either. Told I don't qualify to be seen in the spine clinic but can't get specifics on criteria to be seen. Once again, no community referral over and over and over again. Two White House Hotline complaints and no improvement
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My dentist tells me I need a bottom implant I'm not able to chew my food correctly which causes a lot of stomach problems so if you could help please let me no thank you . Mr James Lafayette
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CW4 Donald Cusack
All you have to do is get your VA dentist to setup an appointment with oral surgery. It should be that simple.
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COL Randall Cudworth
James, a lot of the advice depends on what your status is. For example, if you're a veteran that has a 100% disabled rating by the VA, then you can get free dental care for "any necessary dental care, prosthetic devices, and oral surgery", so that would cover the bottom implant.
Other categories that might apply that the VA would take care of your situation are:
● If you have any DENTAL condition that is service-connected. If it is 10%> then "any needed dental care". If it is 0% (non-compensable service-connected), then it is "Any dental care needed to make sure you have and can keep a functioning dentition (i.e., a working set of teeth)."
●If the issue with your bottom teeth is tied to an existing service-connected condition (regardless of rating)
● Have a service-connected disability (regardless of rating) that's the result of combat wounds or service trauma.
● Former POW
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If you're in any of the above categories, then you need to make sure you're enrolled in VA health care* first and then you can schedule with the dental clinic.
If you aren't eligible for VA dental care, there are many programs available that will assist veterans financially or provide free dental care, but they are usually geographically limited, income limited, or application limited.
A good place to start is with your state's Department of Veterans Services (it might be called something else, but you should easily be able to find it) and they should have a good handle on at least state programs that might be able to assist as well as pointing you towards other non-state programs.
Also, just start searching - again, there's not one specific program that can be pointed to as your circumstances are different than the next veteran. Byte.com* put together a good starting point that has many programs for veterans that aren't eligible for VA dental. You can start there and continue searching (a good internet search would be "dental health care for veterans" with other qualifiers added in (such as "free", "discounted", your state, etc.).
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* Dental Benefits for Veterans - https://www.va.gov/healthbenefits/resources/publications/IB10-442_dental_benefits_for_veterans.pdf
* Enroll in VA Health Care - https://www.va.gov/health-care/apply/application/introduction
* Byte listing of some dental programs for veterans - https://www.byte.com/community/resources/article/veterans-dental-resources/
Other categories that might apply that the VA would take care of your situation are:
● If you have any DENTAL condition that is service-connected. If it is 10%> then "any needed dental care". If it is 0% (non-compensable service-connected), then it is "Any dental care needed to make sure you have and can keep a functioning dentition (i.e., a working set of teeth)."
●If the issue with your bottom teeth is tied to an existing service-connected condition (regardless of rating)
● Have a service-connected disability (regardless of rating) that's the result of combat wounds or service trauma.
● Former POW
●
If you're in any of the above categories, then you need to make sure you're enrolled in VA health care* first and then you can schedule with the dental clinic.
If you aren't eligible for VA dental care, there are many programs available that will assist veterans financially or provide free dental care, but they are usually geographically limited, income limited, or application limited.
A good place to start is with your state's Department of Veterans Services (it might be called something else, but you should easily be able to find it) and they should have a good handle on at least state programs that might be able to assist as well as pointing you towards other non-state programs.
Also, just start searching - again, there's not one specific program that can be pointed to as your circumstances are different than the next veteran. Byte.com* put together a good starting point that has many programs for veterans that aren't eligible for VA dental. You can start there and continue searching (a good internet search would be "dental health care for veterans" with other qualifiers added in (such as "free", "discounted", your state, etc.).
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* Dental Benefits for Veterans - https://www.va.gov/healthbenefits/resources/publications/IB10-442_dental_benefits_for_veterans.pdf
* Enroll in VA Health Care - https://www.va.gov/health-care/apply/application/introduction
* Byte listing of some dental programs for veterans - https://www.byte.com/community/resources/article/veterans-dental-resources/
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SFC Jo Ann Klawitter
I hear you’re pain. I had to have a tooth pulled because of an abscess and I was sent to an oral surgeon and this all comes out of my pocket.
I was lucky I got a dentist that gave veterans Discounts and I took advantage of it and it was a nice discount
Good luck
I was lucky I got a dentist that gave veterans Discounts and I took advantage of it and it was a nice discount
Good luck
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SFC Jo Ann Klawitter
CW4 Donald Cusack good luck finding a VA dentist unless you’re 100% disabled you don’t get any dental care
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This is kind of frustrating for me as I am not allowed to use my retiree dental insurance outside of the VA and I keep falling off the schedule at my local VA. Mainly due to hygienists constantly leaving the VA. My dentist has been great when I see him and they have brought in specialists after hours for things like implants but I keep falling off the schedule. They have offered me community care in the past but I have denied it as my VA dentist is great. Thanks for reminding me to call the dental clinic today! lol
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This is one of the reasons why I don't say yes when I'm asked if they should join the military by young people who are interested in doing that, the VA just doesn't care enough to get the community care system fixed , they are more involved in their own crap and they don't care about us.
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SFC Jo Ann Klawitter
I think all young people should have the experience of joining the military because they need disciplined which they don’t have this day and age
I agree the healthcare system with the VA needs a lot of fixing. It’s worse when you go to Community Care. It gets a little more difficult than if you go to a local VA clinic.
I agree the healthcare system with the VA needs a lot of fixing. It’s worse when you go to Community Care. It gets a little more difficult than if you go to a local VA clinic.
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If you are more than 40 miles from the VA then you can request it. Or if it would take more than 30 days to be scheduled for an appointment you an request community care dentistry. You shouldn't be "shuffled" from one dentist to another because the dentist's office will have a contract to fulfill once they accept you as a patient.
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I have checked with many dental clinic for the cost for implant I just can afford the cost that the dental clinic ask for.
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100% DAV are eligible for all dental care. All other vets must have a SC dental issue.
It starts at your local VA clinic. Make appt. for dental. They will evaluate your conditions,
and most likely refer you to a community care civilian dentist who will again evaluate your conditions and make a recommended course of action back to your VA doc. They , the VA will process the request and submit to a higher level for approval and payment. Once this is done, they will notify you by text and letter your appts. and times. At this point you are well on your way to getting complete quality care just as any self paying person would. you will have no out of pocket expenses and even receive travel pay if you qualify. If needed your care will be coordinated to include crowns, bridges, implants, etc. This seems long and intensive but it's not. From my first VA dental appt. to getting care from my community care Doc "cc" was about 30 days. You will receive copies of all procedures and costs as a courtesy and for you to verify if the work was done. These are the same dentists our civilian counterparts' use. You also may as I have, see a variety of dental specialist if needed for surgical, Endo., prosthodontics etc.
No guarantee but this is how it worked for me . There will be no cost to you. As a 100% DAV you paid this bill in advance.
One last note from an old DAV member, The "Golden Rule" can work wonders.
Hope this helps you to navigate your journey.
Good luck,
"Doc Reece"
HMC Ken Reece
USMC/USN Ret.
Yes I was duel service or OSV
It starts at your local VA clinic. Make appt. for dental. They will evaluate your conditions,
and most likely refer you to a community care civilian dentist who will again evaluate your conditions and make a recommended course of action back to your VA doc. They , the VA will process the request and submit to a higher level for approval and payment. Once this is done, they will notify you by text and letter your appts. and times. At this point you are well on your way to getting complete quality care just as any self paying person would. you will have no out of pocket expenses and even receive travel pay if you qualify. If needed your care will be coordinated to include crowns, bridges, implants, etc. This seems long and intensive but it's not. From my first VA dental appt. to getting care from my community care Doc "cc" was about 30 days. You will receive copies of all procedures and costs as a courtesy and for you to verify if the work was done. These are the same dentists our civilian counterparts' use. You also may as I have, see a variety of dental specialist if needed for surgical, Endo., prosthodontics etc.
No guarantee but this is how it worked for me . There will be no cost to you. As a 100% DAV you paid this bill in advance.
One last note from an old DAV member, The "Golden Rule" can work wonders.
Hope this helps you to navigate your journey.
Good luck,
"Doc Reece"
HMC Ken Reece
USMC/USN Ret.
Yes I was duel service or OSV
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PFC Kay Armstrong
I am 68 and a 100% VA disabled. I have NEVER been able to get a dental appointment! NEVER!!!!!
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I also tried, but the government does not have a dental plan But supposed to be if you were 100% disabled so I have no idea what’s going on
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Suspended Profile
Dental care is an essential part of total health and should be afforded to anyone needing it, regardless of rating. I have been fighting this issue for a long time. Also even my colleagues with a 100% rating are fighting to get dental care but the clinic is overwhelmed. Community Care services are constipated at the very least. I hope this situation changes for all of us.
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