Blue Cross / Blue Shield Dental Coverage

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Avoid the stress-don't get bcbs dental
Posted on
Rating: 1/51
QUINCY, MASSACHUSETTS -- So bcbs dental acts like they care about prenatal care by offering 3 cleanings a year to pregnant woman. What they don't tell you is that 8 months after the cleaning you will still be calling bcbs (weekly) to send payment. After customer service told me 3 different providers had to fill out the documents saying I was pregnant they still denied the claim. Long story short (and it is long given the many MANY calls required to Blue Cross blue shield) I actually only was able to get 2 cleaning that year. Not only was I denied service that I was entitled to but they still are not paying my dentist for the cleaning!!!!! This has been the most stressful experience I have had with an insurance company. I highly recommend staying away from this company and will advise my staff to do the same!
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User Replies:
clutzycook on 03/06/2013:
Just a question, but why would a pregnant woman need three teeth cleanings in a year? Of course, I haven't been to a dentist in 13 years, so even the concept of going every 6 months seems a bit much.
Anonymous on 03/06/2013:
From I can recall, oral infections, such as in your gums, can be harmful to a fetus. My dentist and OB only recommend a cleaning every 6 months even if pregnant, not 3 times in a 9-10 month period! I agree that 3 times in less than a year is excessive. With proper oral care, I don't agree that pregnant women need a cleaning every 3 months, but then again I'm not a health professional either, just a mom :)
Anonymous on 03/06/2013:
Also all BCBS dental plans (we have one too) have an annual maximum benefit. Is it possible the 3rd exam was denied because you maxed out your benefits? As most your maximum benefit would be $1500 I believe.
trmn8r on 03/06/2013:
I just had mine cleaned yesterday - my dentist wants them to be every 6 months, and I'm cheap so go for a 9 month interval.

As clutzy mused, 3 times a year seems extreme. Maybe there is something weird about being pregnant (aside from all the obvious things) that causes accelerated plaque/tartar buildup.
*Brenda* on 03/08/2013:
Being pregnant is hard on your teeth. A LOT of women get a ton of cavities after being pregnant. The baby sucks the life out of you, lol. My dentist didn't suggest I go more though.
Ruth on 11/05/2014:
Blue Cross Dental HMO is the worst plan ever, don't waste you money! After spending a ton of time on the computer searching out participating dentists and calling them to find out about them, then making a decision of which one I wanted to be my primary dentist. Then I had to go back to the web site and put in the facility number, which I did only to learn that it was not received or recorded, so all of my claims were denied. No working with me to try to figure out what happened and correct the error. No. NO PAYMENT< END OF STORY
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Misleading Agents
Posted by on
I carry Blue Shield PPO. Moved to a new city (Blue Shield raised my rate based on my new zip code). Was recommended to a new dentist by a friend, so I decide to check to make sure I was covered before seeing said dentist.

1) Called Blue Shield to see if I could see the dentist under my plan. Was told yes.
2) Called dentist to see if they accepted Blue Shield. Was told yes.

Both were lying. My bill for cleaning, xrays, and two replacement fillings is now $1410, of which Blue Shield paid a little over a hundred.

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dan gordon on 03/25/2010:
Not sure I understand the issue, but of course you can see any dentist you want. Were they in your plan? who knows? Did you have to have a referral? Were they in network or out of network? I think you should have asked more questions. This is the case with any insurance. Of course the destist takes Blue Cross, but how do they know which policy you carry?
Anonymous on 03/25/2010:
Did you check to make sure the work you were getting was covered under your plan? Are you looking at a statement of benefits and not a bill? Did you pay the deductible?
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BlueCross Dental South Carolina Does Not Pay What It Says It Will Pay
Posted by on
COLUMBIA, SOUTH CAROLINA -- I went to the dentist for preventative care (x-rays, cleaning, exam) and in the BlueCross handbook it stated it paid 100% for those services. I called to ask BlueCross and they confirmed this to be true, and I also asked if I had to go to a network provider, and the agent said there weren't any network dentists, and I could go anywhere.

So I had a booklet stating 100% would be covered and a verbal agreement that 100% would be covered. About a week after I went to the dentist I received a bill from the dentist and it stated that the insurance had only paid 37% of my claim.

This is what BlueCross paid $21 on a $73 exam, $31 on a $75 cleaning, $40 on a $93 full mouth x-ray, and $12 on a $38 bite-wing x-ray. Leaving me to pay $175 on a $279 bill, which I thought would be 100% covered.

I am angry because I checked the booklet and with the agent, and thought I was safely covered. In today's economy people can't afford surprises, and that is why I am filing this complaint as a warning for others.

I believe they should pay the rest of my bill and will complain and post on sites until they do.

Do Not Get BlueCross BlueShield Dental Insurance!
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grandma005 on 02/26/2009:
This is why I cancel Blue Cross Dental Insurance years ago. I was paying $100.00 a month. So many things were excluded and paid only a fraction of what was included. For the whole year they only paid like $400.00 for a 1200.00 premium. Total rup off. Don't get this insurance Better off paying cash.
Anonymous on 02/26/2009:
When they state they will pay 100% it doesn't mean they will pay what ever the dentist charges. They will pay 100% of they have determined is customary for that particular service. Most times it is a lot less than what the detist actually charges.
jktshff1 on 02/26/2009:
When using your insurance, you need to discuss charges with your Dr's office and what they will and won't accept. Robf is right.
Anonymous on 02/26/2009:
Robf is 'partially' right. If the doc is a 'participating provider' he/she agrees to accept the fee set by the insurance company. Some plans will pay 80-100% of the 'approved' fee. If the doc contracted for $75, he/she will get 80% ($60) and accept that. If the deductible has been met and there is no copay, the patient could walk away owing nothing. But, if the doc is not contracted to the plan, insurance 'may' pay (typically) 80% of the plan's benefit amount. So, if a doc charges $100, and the plan's approved fee is $75, insurance will pay 80% of $75 ($60), leaving $40 to be paid by the patient, plus the copay (if any). Remember, the copay (around $20) is the amount the insurer requires as paid by the patient to trigger coverage. So, this patient could end up paying $60 for a '$75 procedure'. It pays to know the details.
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