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Dr. (Capt.) Amanda Nelson, left, prepares a tooth for a crown for Pfc. Nathaniel von Beitler at the Darmstadt, Germany, dental clinic as Rita Marshall assists.
Dr. (Capt.) Amanda Nelson, left, prepares a tooth for a crown for Pfc. Nathaniel von Beitler at the Darmstadt, Germany, dental clinic as Rita Marshall assists. (Michael Abrams / S&S)

HEIDELBERG, Germany — After years of bitter complaints, the European Regional Dental Command is hoping to make dental care less of a headache for military family members.

U.S. Army Europe officials are seeking Pentagon approval to provide families with a list of “preferred providers” — local European dentists proven competent — and dental advisers to help with questions and insurance paperwork.

Only dentists who do not demand upfront payment and are willing to file claims directly to insurers would be on the list.

“Our soldiers and their families should not be forced to guess about the quality of their overseas dentists, nor should they have to pay reimbursable expense upfront,” said a letter signed by Gen. David McKiernan, USAREUR commander, to the assistant Defense secretary for health affairs.

McKiernan’s Jan. 23 letter to William Winkenwerder Jr. points out that military families in the states insured through Tricare Dental Program have a quality-assured preferred provider network of dental advisers, and don’t have to pay the costs of the procedure upfront. Those in Europe don’t enjoy the same benefit.

“With your support, we can offer our soldiers and their families one less thing to worry about by providing predictability and consistency in this part of their lives,” the letter says.

Before Sept. 11, 2001, and subsequent deployments from Europe to war zones, that wasn’t a problem. In fact, free dental care for the whole family at an on-base dental clinic was one of the perks of being assigned to Europe.

“You’ll even hear people say, ‘We waited to come to Europe to get the kids braces,’” said Col. Michael Cuenin, ERDC commander.

While some families now transferring from the States cancel their stateside dental insurance, believing free care is still available, they are six years too late.

“The rules haven’t changed. We’ve refocused,” Cuenin said.

Because soldiers’ teeth come first, most family members nowadays must get their dental care off-base. They must seek out a local national dentist, whom they don’t know, possibly have trouble understanding and who demands payment upfront.

While Tricare does provide a list of German dentists, the only listing criteria is that the dentist be licensed and take U.S. insurance, Cuenin said.

“Right now, all we’re able to say is, ‘Here’s the (Tricare) Web site.’”

]But that will change under the new program, which USAREUR is optimistic will happen. “We’re going to have a network and we’re going to hold [the dentists] accountable,” Cuenin said.

Some family members have done what retirees — even further down on the space-available list and for all practical purposes, off the list — and some civilian Department of Defense workers do. They ask around for a good dentist, make sure the dentist accepts U.S. insurance and become accustomed to the fact that they’ll have to pay perhaps thousands of dollars the day of treatment and wait for the insurance company reimbursement.

At one German dentist popular with Americans, the fee for a cleaning is $103.50. A ceramic filling is $776 and a root canal is $517.

Plus, patients sometimes have had to contend with insurance companies that don’t understand the charges listed are in euros and other annoyances that delay reimbursement.

The new dental program is expected to be up and running in the next 18 months or so, Cuenin said, after a new contract is reached with Tricare.

“Ideally, you’ll come to the clinic and see the dental benefits adviser, and she’ll walk you through it,” Cuenin said.

The adviser could help people choose a suitable dentist, as well as help with paperwork and other problems.

One woman recently expressed her frustration finding a dentist with a parking lot, for instance, Cuenin said. She drove a large truck.

Deployments shape makeup of clinic patients

HEIDELBERG, Germany — The European Regional Dental Command’s 32 clinics worked on about 1,300 patients each day last year, performing more than 4,000 procedures, according to Col. Michael Cuenin, ERDC commander.

The majority of patients — 60 percent — were soldiers, who are required to be seen before deployment and upon their return.

When the servicemembers return, after a year or more of living in the desert and drinking a lot of Gatorade, many might need two to four appointments.

“There’s a lot of sugar, less saliva, more caries,” Cuenin said.

U.S. military dentists continue to treat some U.S. family members, who they say make up about 39 percent of appointments Europewide, on a space-available basis. Most, Cuenin said, are children and people with complex dental problems — those believed to be most in need of seeing a U.S. dentist.

“And we never turn anyone away who has discomfort or an emergency,” he said.

The fact that some family members receive care has heightened others’ perceptions that they’re being ill-served, Cuenin said.

“The problem occurs, people see each other in the stairwell: ‘Well, how come you’re getting in for treatment?’ We triage,” he said.

“I do take complaints. Multiple complaints. But I understand it. It’s a passionate subject.”

The chances of a family member getting a space-available appointment varies widely, depending on whether soldiers are deploying, returning or deployed.

In Schweinfurt, for example, after soldiers deployed, 60 percent of appointments were taken by family members.

And in Vicenza, Italy, which is destined to be among the Army “hubs” after transformation, the clinic recently was expanded by 10 chairs, along with its staff. So family members there were able to get appointments: 48 percent of all appointments, in fact.

— Nancy Montgomery

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Nancy is an Italy-based reporter for Stars and Stripes who writes about military health, legal and social issues. An upstate New York native who served three years in the U.S. Army before graduating from the University of Arizona, she previously worked at The Anchorage Daily News and The Seattle Times. Over her nearly 40-year journalism career she’s won several regional and national awards for her stories and was part of a newsroom-wide team at the Anchorage Daily News that was awarded the 1989 Pulitzer Prize for Public Service.
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