Does BCBS Cover Dental Surgery?

Blue Cross Blue Shield (BCBS), a federation of health insurance companies recognized all over the United States. They provide many different health insurance plans, each designed to fit the unique needs of their customers

When it comes to the coverage of dental surgery, the specifics can really differ from one BCBS plan to another because health insurance policies are complex and aim to meet different health needs.

In this article, we will explore the types of dental surgeries covered by BCBS plans, and how policyholders can determine their eligibility and the extent of coverage. We will also discuss some important considerations to keep in mind when planning for dental surgery under a BCBS plan.

Understanding BCBS Dental Coverage

BCBS dental coverage usually includes a variety of procedures intended to maintain oral health and treat dental issues. This can range from preventative services like cleanings and routine exams, to basic dental work like fillings and extractions, and even more complex procedures including root canals and orthodontics.

Coverage for major dental surgeries, such as dental implants or major jaw surgeries, is more variable and often depends on the specific plan and medical necessity. Policyholders should review their plan details or contact BCBS directly to understand their specific coverage options and any pre-authorization requirements for dental surgery.

Types of Dental Insurance Plans Offered by BCBS

BCBS offers different types of dental insurance plans, designed to fit various needs and preferences. Here are some common options:

• Dental Health Maintenance Organization (DHMO): This plan usually requires members to choose a primary dentist from a network. It emphasizes preventative care and offers low-cost or free routine procedures. However, it may have limited coverage for specialist care.
• Preferred Provider Organization (PPO): PPO plans offer more flexibility in choosing dentists and specialists, even outside the BCBS network, but they cost more. They usually pay for part of your dental work, and you pay the rest.
• Exclusive Provider Organization (EPO): Similar to PPO plans, EPOs offer a selected network of dental care providers. Members must stick to the network for coverage, except in emergency situations.
• Discount or Dental Savings Plans: These plans aren’t exactly insurance but offer discounts on dental services at some dentists which makes them a cheaper option than regular dental insurance, especially for people who can’t get standard plans.

Each plan comes with its own rules, coverage options, and limitations, so it’s important for individuals to review the specific details and compare them against their dental care needs and financial situation.

Dental Surgery Under BCBS

When it comes to dental surgery, the coverage details can get a bit complex. Dental surgery includes many different procedures, from simple tooth extractions to more involved operations like implants or orthognathic surgery.

Is Dental Surgery Covered by BCBS?

The short answer is Yes, dental surgery is often covered by BCBS plans, but the extent of coverage depends on your plan and what kind of surgery you need.

Usually, surgeries that are deemed medically necessary, like those required to treat injury, disease, or congenital defects, are more likely to be covered. However, cosmetic surgeries, which are performed solely to improve appearance, may not be covered or may have limited coverage.

It’s important for people with insurance to check their benefits by consulting their plan’s coverage documents or contacting BCBS directly.

What is Considered Dental Surgery?

Dental surgery includes many different types of procedures, each with its own purpose and requirements. Here are some common types considered under dental surgery:

• Tooth Extractions: Including wisdom tooth removal, often necessary for relieving overcrowding or addressing decay.
• Dental Implants: Used to replace missing teeth, these involve surgically inserting a metal post into the jawbone, followed by attaching an artificial tooth.
• Root Canal Therapy: A treatment for infected or decayed teeth, where the damaged inside of the tooth is cleaned and sealed.
• Periodontal Surgery: Aimed at treating gum disease and damage, which might include grafting to replace lost gum tissue.
• Orthognathic Surgery: Corrective jaw surgery intended to address jaw misalignments or abnormalities, often required for both functional and aesthetic reasons.
• Reconstructive Surgery: After an injury or illness, doctors do surgeries to fix and make the mouth and jaw area look normal again.

What Specific Dental Surgeries Are Covered by BCBS

The dental surgeries that BCBS plans cover can really differ based on your policy details and if the surgery is needed for health reasons. Here’s a simple overview of surgeries that might be covered:

• Tooth Extractions
• Root Canal Therapy
• Dental Implants
• Periodontal Surgery
• Orthognathic Surgery
• Reconstructive Surgery

Remember, your plan might not cover everything for dental work. It could have limits, and you might have to pay some money yourself, like for deductibles or sharing the cost, even if it pays for your surgery.

Read also: Does Kaiser Accept Anthem Blue Cross?

Determine the exact dental surgeries covered by your BCBS plan

To accurately determine the dental surgeries covered under your Blue Cross Blue Shield (BCBS) plan, follow these key steps:

• Plan Documents and Member ID Card: Start by reviewing your plan documents or member ID card, which should have information about covered procedures and any pre-authorization requirements.
• Contact Customer Support: Reach out to BCBS customer service directly. Have your policy number ready and ask specific questions regarding dental surgery coverage.
• Understand Deductibles and Co-Pays: Inquire about any deductibles that must be met before coverage kicks in, and learn about co-pay or co-insurance rates for dental surgeries.
• Seek Information on In-Network Versus Out-of-Network Coverage: Determine whether your plan restricts coverage to in-network providers and, if so, request a list of in-network dental surgeons.
• BCBS Website: Use your plan name to search the site or explore the dental area for details on what services are covered. Look for resources such as policy documents or FAQs to understand what surgeries are included.

By taking these steps, you can gain a clear understanding of the dental surgeries covered by your BCBS plan, helping you to plan accordingly and avoid unexpected expenses.

Conditions and Limitations for Dental Surgery Coverage

Understanding the conditions and limitations for dental surgery coverage under your BCBS plan is crucial to fully leveraging your benefits and avoiding surprise bills.

Conditions:

• Waiting Periods: Some BCBS plans might have waiting periods before you can get benefits for surgery. This means you might need to be signed up with the plan for a certain time (like 6 months) before they help pay for big treatments like surgery.
• Pre-Existing Conditions: If your dental surgery is for a pre-existing condition, it may not be covered until you have been on the plan for a specified period.
• Pre-Authorization: Some surgeries require pre-authorization from the insurance company before they can be covered. Make sure to check with your plan beforehand.

Limitations:

• Annual Maximums: BCBS plans often have an annual maximum for dental benefits, which means they will only cover up to a certain amount of expenses per year. Once this limit is reached, you may be responsible for all additional costs.
• Coverage Percentages: BCBS plans usually fully cover preventive care, but for major procedures such as surgeries, they may only cover a portion. For example, they might pay for 80% of the cost for removing a wisdom tooth, leaving you to pay the remaining 20%.
• Out-of-Network Coverage: If your plan has a limited network, you may be responsible for additional costs if you choose to go to an out-of-network provider.
• Frequency Limitations: Some dental surgeries may have limitations on how often they can be performed like a maximum of two root canal procedures per year. Be sure to check your plan’s limitations for more details.

Conclusion

Understanding dental surgery coverage with your BCBS plan might look tough but by carefully checking your benefits and using the right approach, you can make informed decisions.

By knowing which surgeries are covered and the rules that apply, you can take care of your dental health and save money. Don’t forge to check your plan, talk to BCBS customer support if you need to and try to use dentists in your network to get the most out of your coverage.

FAQ

Will BCBS cover my entire dental surgery cost?

No, BCBS may not cover the entire cost of your dental surgery. Coverage will depend on your specific plan details, including deductibles, co-pays, or co-insurance rates, and whether the procedure is performed by an in-network provider. You will likely be responsible for a portion of the costs.

Can I choose any surgeon for my dental surgery under BCBS?

Whether you can choose any surgeon for your dental surgery under Blue Cross Blue Shield (BCBS) depends on your plan type. If your plan is a PPO, you may have the flexibility to choose an out-of-network surgeon but at a higher out-of-pocket cost. However, if you have an HMO plan, you are typically required to select a surgeon within the BCBS network to be covered.

What does Blue Cross Blue Shield cover for dental?

Blue Cross Blue Shield offers many dental services in its plans, including preventive care like cleanings, exams, and X-rays, basic procedures such as fillings and extractions, and major services that can include root canals, bridges, crowns, and occasionally, orthodontics. Coverage specifics, however, greatly depend on the type of plan held and the policy details, including any deductibles, co-pays, and network provider requirements.