Blue Cross / Blue Shield PPO Dental Exclusions, Limitations, Frequencies and Missing Tooth Clause
Sunnyvale Dentist Dr. Antonius is a longtime in network provider for Blue Cross / Blue Shield PPO (Preferred Provider Organization) dental insurance. Besides providing excellent expert care, he has agreed to accept the reduced Blue Cross / Blue Shield PPO dental fees for all patients with this coverage. Understanding all of the details of an insurance plan can be daunting. Dr. Antonious and the staff at Sunnyvale Dental Care will help you understand the specifics of your insurance plan.
Your Blue Cross / Blue Shield PPO dental insurance plan will be very helpful in defraying your cost for dental care. Although it will not pay 100% of all services, covered services may be covered at 50% to 100%.
All insurance plans whether they are medical or dental have limitations and frequency rules. Dental insurance plans may also have a missing tooth clause. These determine which materials may be used for fillings and crowns, the number of exams, x-rays and cleanings you’re permitted each year, and how often dental prosthetics such as partials and dentures may be replaced.
If your individual insurance plan has a missing tooth clause, this means that the replacement of any tooth or teeth lost prior to purchasing the Blue Cross / Blue Shield PPO dental insurance plan would not be a covered expense. The bridge, partial denture, full denture, or implant needed to replace the tooth or teeth would be your responsibility.
Depending on which Blue Cross / Blue Shield PPO dental plan you or your employer has chosen, there may be various exclusions. According to one Blue Cross / Blue Shield PPO dental plan, Blue Cross / Blue Shield PPO dental insurance consultant may exclude a procedure that they consider to be “not clinically necessary, performed solely for cosmetic reasons, procedures considered experimental, and procedures that can be effectively treated by a more cost-effective, clinically acceptable alternative procedure.”
Treatment recommended by Sunnyvale Dentist Dr. Antonious may be excluded not because it’s unnecessary, but because insurance companies like most businesses strive to save money wherever possible. The insurance coordinator at Sunnyvale Dental Care will be happy to submit a pre-authorization/pre-determination of benefits form to Blue Cross / Blue Shield PPO on your behalf prior to treatment.