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Anthem Blue Cross : Dental

Dental

PW_A116884

Members' Frequently Asked Questions about Dental Blue:

What is Dental Blue?

What is the difference between the Dental Blue 100, 200 and 300 Networks?

Are referrals required to see a dental specialist?

What dental services are covered?

Where can I get a list of covered procedures?

Is there a waiting period after enrollment before I can use my benefits?

Can I enroll in dental coverage after my company's open enrollment period has ended?

Will I get a price break on non-covered services, such as implants?

What happens after I reach my calendar year maximum?

How will my dental claims be paid?

How can I find out about the status of my dental claims?

How do I find a Dental Blue dentist or specialist?

I only want to visit dentists in my network. How can I be sure that a dentist is in my network?

Will my costs vary depending on which network I select?

What if I want to visit a non-Dental Blue dentist?

My dentist is not listed in either the Dental Blue 100, 200 or 300 Network. Can I still go to him/her?

My dentist is not in any of the Dental Blue Networks, but I would like him/her to join. What can I do?

My dentist says that he accepts all insurance plans. Why can't I find his name in your directory?

If I am traveling out of state and need to see a dentist, will I be covered?

Who do I contact if I still have a question?

 
What is Dental Blue?
Offered by Anthem Blue Cross Life and Health Insurance Company (Anthem Blue Cross Life and Health Insurance Company), Dental Blue gives you the power to use your dental benefits the way you want. The majority of California dentists participate in one of our three networks: Dental Blue 100, Dental Blue 200 or Dental Blue 300. You can visit any of these dentists for preventive services like cleanings to more involved services like extractions or crowns. Dental specialists like oral surgeons and endodontists participate in all the Dental Blue networks.  
Dental Blue dentists decide which of our networks to join. What you pay for dental services will vary depending on which network the dentist you visit is in. Bottom line: You get the greatest savings when you visit a dentist in the Dental Blue 100 network.  
Click here to view a demo of this exciting new Dental coverage concept.  
 
What is the difference between the Dental Blue 100, 200 and 300 Networks?
All of the dentists and specialists in the Dental Blue Network have been thoroughly evaluated and NCQA-credentialed. There are two differences, though: provider reimbursement level and network size. Dentists in the 100 Network have agreed to accept lower reimbursements than dentists in the 200 network, who have agreed to accept lower reimbursements than dentists in the 300 network. The Dental Blue 300 Network has the most dentists, followed by the 200 Network and then the 100 Network.  
 
Are referrals required to see a specialist?
No, a referral is not required to see a dental specialist. You have the freedom to select any licensed specialist, although visiting a non-Dental Blue specialist may cost you more.  
What dental services are covered?
Most Dental Blue benefit options include coverage for Preventive, Diagnostic, Restorative, Endodontic, Periodontic, Oral Surgery and Prosthodontic services. These services are explained in your group dental benefits plan. Please refer to your Certificate for complete coverage, conditions, exclusions and limitations.  
 
Where can I get a list of covered procedures?
A complete list of covered services is available in your group dental benefits plan. If you would like to find out if a particular procedure is covered or how much it would cost, you may call Dental Customer Service at the number on your ID card.  
Is there a waiting period after enrollment before I can use my benefits?
While each plan is different, there are no waiting periods for Preventive (e.g., cleanings) or Diagnostic (e.g., exams) services. To determine if there are waiting periods for other services, please refer to your Certificate.  
Can I enroll in dental coverage after my company's open enrollment period has ended?
No. The only time you can enroll in your company's dental plan is during the open enrollment period.  
Will I get a price break on non-covered services, such as implants?
Dental Blue dentists have agreed to extend their Dental Blue negotiated discounted fees to members for many non-covered and cosmetic procedures. This could include implants, braces and teeth whitening. The discounted fees are also available during waiting periods and after you have reached the annual maximum your plan allows.  
What happens after I reach my calendar year maximum?
Dental Blue dentists have agreed to extend their Dental Blue negotiated discounted fees to members after the calendar year maximum has been reached, so you’ll continue to pay our negotiated fees, which are less than what dentists typically charge.  
How will my dental claims be paid?
When you use a Dental Blue dentist, you do not need to submit a claim form for covered dental expenses. Your dentist will complete and submit the claim form to Anthem Blue Cross. Anthem Blue Cross will pay the benefits of the plan directly to your dentist. If your dentist is not in a Dental Blue network, you may have to complete and submit your own claim forms. In either case, you are required to pay the dentist directly any coinsurance or deductible amounts and any charges for non-covered services. 
 
How can I find out about the status of my dental claims?
You can obtain claims information by visiting the member self-service location on our web site (Member Services), or by calling the Dental Customer Service number on your ID card.  
 
How do I find a Dental Blue dentist or specialist?
You can find the names, addresses, specialties, telephone numbers and networks of Dental Blue dentists in your area by searching our online provider directory with Provider Finder. You may also contact Customer Service by calling the telephone number on your ID card. A personalized list of dentists and/or specialists within a specified radius can be provided to you.  
I only want to visit dentists in my network. How can I be sure that a dentist is in my network?
Follow the prompts on Provider Finder until you get to the prompt that asks you to “Please select a Dental Blue Network.” At that point, check your ID card to verify your network. Be sure to select that network from the drop-down menu. If your ID card says “Dental Blue 100/200/300, you may select “All Dental Blue Providers” from the drop-down menu.  
PLEASE NOTE: If you are looking for a specialist, you may select any network. Dental Blue specialists participate in all three networks, so your out-of-pocket costs will be the same for specialist services no matter what network is on your ID card.  
Will my costs vary depending on which network I select?
In most cases, yes. Check your ID card for your network.  

If your Network is Dental Blue 100: You will save the most money by visiting dentists in the 100 Network. You will save less with a 200 Network provider, and even less for a 300 Network provider.

If your Network is Dental Blue 200: You will save the most money by visiting dentists in the 200 Network. You will save less with a 300 Network provider.

If your Network is Dental Blue 300: You will save the most money by visiting dentists in the 300 Network.

If your Network is Dental Blue 100/200/300: You will save the most money by visiting dentists in the 100 Network. You will save less with a 200 Network provider, and even less for a 300 Network provider.

 
With all of our networks, you will benefit from our lower, negotiated fees. If you go to a provider who is not in any of our networks, you will not enjoy the cost protection available by using the network. (See your benefit summary for details.)  
 
What if I want to visit a non-Dental Blue dentist?
You’re always free to visit any licensed dentist, even those who are not in the Dental Blue Networks. With a Dental Blue dentist, though, you will always enjoy our lower, negotiated fees. If you go to a dentist who is not in any of our networks, you will not enjoy the same cost protection and will probably pay more.  
My dentist is not listed in either the Dental Blue 100, 200 or 300 Network. Can I still go to him/her?
Yes, but if you go to a non-Dental Blue dentist, you will probably pay more for services. If you choose one of our Dental Blue Network dentists, however, you will usually pay less for services.  
My dentist is not in any of the Dental Blue Networks, but I would like him/her to join. What can I do?
You can complete a Provider Nomination Form and request that we send your dentist an application to join Dental Blue. We will mail an application directly to your dentist's office. Or you can call the Dental Customer Service number on your ID card and provide the name and address of your dentist. We will contact your dentist and start the contracting process. 
My dentist says that he accepts all insurance plans. Why can't I find his name in your directory?
First, verify the spelling of your dentist’s name and/or the name of the dental office. If you still can’t find it, it is possible that your dental office "accepts" patients enrolled in various insurance plans without actually "participating" in their networks. Prior to receiving treatment, you should check with the dental office to be certain of its participation so that you can maximize your plan benefits.  
If I am traveling out of state and need to see a dentist, will I be covered?
The Dental Blue Network is available across the U.S. You can use Provider Finder to locate the nearest Dental Blue Network provider.  
Who do I contact if I still have a question?
If you still have questions, you may contact your company’s benefits administrator or call Dental Customer Service at the number on your ID card.  
 

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Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association.