Emergency/Urgent dental care procedures under the ADDP for National Guard and Reserve members on active duty for 30 days or less consist of the following:
Urgent Care is defined as services required to prevent serious deterioration of health and oral health following the onset of an unforeseen condition (i.e., severe oral pain, bleeding, infection, unexplained swelling in the oral cavity or supporting structures, fever associated with a potential oral abscess, broken filling/restoration that will not allow the SM to perform the mission). Treatment for the urgent care condition must be completed while the service member (SM) is on active duty status. Urgent care conditions covered by the ADDP are limited to the minimum treatment required to alleviate the immediate urgent dental condition and return the SM to duty. Examples of care authorized under this process include extraction of a single tooth; placement of a restoration; incision and drainage; or pulpectomy. However, this process is not authorized to provide payment for routine dental care. Urgent care claims can be paid with expedited LOD documentation as long as the urgent care is provided while the SM is in an active duty status and information documenting the SM’s active duty status is provided from the military unit. Full LOD documentation is required to allow authorization for payment of claims when the SM is no longer in an active duty status or additional follow-up care is required.
LOD Process for Urgent Care Conditions - The ADDP will use an expedited process for approval of urgent care LOD conditions.
a. The SM is entitled to urgent care from a civilian provider during the period of active duty status limited to care to the definitions of urgent care above. The SM may also receive any care that can be provided by an active duty DTF during the time of active duty status.
b. It is the SM’s responsibility to report the injury, illness or disease to their unit chain of command/medical authority. The SM’s unit/ medical authority is responsible for initiating the urgent care LOD documentation.
c. No follow-up dental treatment resulting from an urgent care LOD encounter will be authorized. Eligibility will not likely be reflected in DEERS for the date of LOD injury if the SM was on active duty status for 30 days or less.
d. The SM’s civilian provider will return the ADDP claim form to the SM’s military unit. The SM’s unit/medical authority will submit the ADDP claim form and a Command Memorandum detailing the request for urgent care.
e. Only care directly related to the aforementioned illness /disease as documented in the urgent care LOD documentation/Memorandum will be authorized for payment through the Contractor/ADDP/military Dental Service Point of Contact (DSPOC) process.
NOTE -- The U.S. Army Selected Reserve Dental Readiness System (ASDRS) provides Class 3 dental care to U.S. Army Reserve Component Soldiers. If the urgent condition results in a Class 3 condition, Army Soldiers should request a DD2813 (or a copy of the ADDP Claim form) that documents the Class 3 condition. The Soldier can then use the ASDRS program to remedy the Class 3 condition.
Army Guard Soldiers should contact LHI at 888-901-6609 for their Class 3 care.