About DentalBlue

About DentalBlue

DentalBlue™ plans from BlueCross BlueShield of Tennessee offer you flexibility, convenience, and exceptional customer service – all from one of the most trusted names in the business.

Preventive dentistry is a key factor in helping prevent major dental bills.  BlueCross BlueShield of Tennessee has made preventive dentistry the focus of its dental coverage.

Despite increased attention to their health, many adults neglect dental care.  An estimated 7 million days of work are lost in the United States annually because of "dental conditions."  Many of these conditions increased in severity because of poor dental hygiene and failure to practice preventive dentistry.  In fact, approximately 98 percent of all serious dental problems begin with gradual deterioration of the teeth and gums.

With DentalBlue™ from BlueCross BlueShield of Tennessee, you have an incentive to visit their dentist regularly.  Unlike many health care benefits that will be used by a small fraction of members, dental plan benefits encourage a routine dental exam every six months.  This is the best way to assure small dental problems won't become large, expensive ones.

Plan Option and Benefits

BlueCross BlueShield of Tennessee has many standard plan designs. Check your schedule of benefits to see the plan option, plan limits, deductible and coinsurance levels that apply to you.

Your benefits are arranged into four levels of coverage, A-D, as summarized below. Some plans do not include coverage for all four levels. Check your schedule of benefits to see your plan specifics. Not all dental services are covered by this plan. Check the exclusions and limitations to see what is not covered.

Coverage A

  • Diagnostic Services – exams, x-rays
  • Preventive Services – prophylaxis (cleanings), fluoride, sealants, and space maintainers

Coverage B

  • Basic Restorative Services – amalgams restorations (silver filings), resin composite restorations (tooth colored filings), and stainless steel crowns
  • Basic and Major Endodontics – pulpotomy, pulpal therapy, and root canal treatment
  • Basic and Major Periodontics – non surgical periodontics, including periodontal scaling and root planning, debridement and periodontal maintenance procedures; surgical periodontics, including gingivectomy, osseous surgery, and grafting
  • Basic and Major Oral Surgery – non surgical or simple extractions, surgical extractions and other surgical procedures typically not covered under a medical plan
  • Other Services – palliative (emergency) treatment for relief of pain, denture repairs.

Coverage C

  • Major Restorative – crowns, inlays, onlays, veneers, and other restorative services
  • Prosthodontic Services – fixed partial dentures (bridges), removable dentures, and other prosthodontic services

Coverage D

  • Orthodontic Services – for the straightening and alignment of teeth, including exams, photographic images, diagnostic casts, x-rays, installation, and adjustment of orthodontic appliances.

DentalBlue Network

With over 2,000 dentist locations in Tennessee and bordering counties outside of Tennessee, DentalBlue plans have the largest PPO network in Tennessee. Now, DentalBlue offers even more. When you are outside of the Tennessee service area, you can still choose to see a network dentist through DenteMax, our national network. DenteMax contracts with over 75,000 dentists in all 50 states giving you the option to use a network dentist anywhere. To locate a DenteMax provider simply go to BCBST.com, find a doctor. Click dentist and select the DenteMax network option. You can search by city, state, or zip code to find a dentist near you.

DENTALBlue Network Basics

Participating Dentists

Participating dentists agree to accept the BlueCross BlueShield of Tennessee or DenteMax dental network maximum allowable fee schedule as full payment for services rendered.  Participating dentists can only collect from the patient any deductible, coinsurance, and non-covered services/supplies.  Coinsurance is determined by the BlueCross BlueShield of Tennessee or DenteMax allowed amount for covered dental services.  A directory of Participating Dentists will be furnished to you or for the most up to date information you can check on line at BCBST.com.

Predetermination of Benefits

Except for emergency care, the subscriber and dentist can determine exactly what is covered by the dental program and the amount the program will pay before treatment begins.  Following the examination appointment, the treating Dentist's Statement is completed by the dentist and submitted to BlueCross BlueShield of Tennessee.  The dentist and subscriber are then notified of exactly what benefits will be provided by the dental program. We recommend a predetermination for any service where the charge exceeds $200.

Payment For Services By A Non-Participating Dentist

Under DentalBlue, you are free to go to the dentist of their choice.  This is often referred to as a passive PPO.  Should you visit a non-participating dentist, the payment will be based on a maximum allowable fee schedule and may be made directly to you.  A non-participating dentist may charge more than the amount of the maximum allowable fee schedule, and this difference would be your responsibility and is sometimes referred to as balance billing.

Why Are Dental Networks So Important?

Control Balance Billing

Dentist fees rise steadily each year, and there is a wide disparity in the fees they charge.  Insurers control client benefit costs by setting an upper limit on the fees they will pay .  Since network dentists agree to a discounted fee, they cannot balance bill the difference from their full fee.

Did you know balance billing by non-network dentists can result in you paying up to 30% more?

Stretching Your Dental Benefit Dollar

Even though some restorative and specialty services cost $1,000 or more, most dental plans still have an annual maximum benefit of $1,000.  When network dentists discount their fees, you save money.  This translates into less benefit used and more benefit left over.

Did you know you already pay 30% or more of dental costs through coinsurance, deductibles, and plan limits?

Added Value

You’re just a phone call away from BlueCross BlueShield of Tennessee’s highly trained customer service representatives who know and understand every aspect of your benefit plan.  Along with a host of other support tools available on  www.bcbst.com, BlueAccess enables you to look up claims and view benefits online, any time.

Vision discounts and more with BluePerks

In addition to the great benefits with our DentalBlue plans, you also get value-added discounts with BluePerks.  Created exclusively for our members, BluePerks features discounts of up to 30% on non-covered products and services like routine vision and LASIK corrective vision surgery.  Unlike many other dental plans, we don’t stop with vision discounts!  BluePerks also includes discounts on weight loss programs, cosmetic surgery, vitamins, health club memberships, personal trainers, massage therapy, spa services, acupuncture and other Complementary Alternative Medicine (CAM) procedures.  Taking advantage of BluePerks is easy.  There are no necessary referrals or paperwork to complete. Check on line to find a provider near you and just flash your BlueCross BlueShield of Tennessee membership card when receiving products and services from the more than 28,000 affiliated practitioners in 36 CAM disciplines coast to coast and receive instant discounts of up to 30 percent.

Page Modified:May 18, 2012