Dental Blue® PPO

Dental Blue® PPO

 

Your Dental Blue Freedom coverage consists of: a Dental Blue PPO plan; and a Dental Blue plan.

In-Network Benefits

Dental Blue PPO is a preferred provider dental plan. This means that you will receive the highest level of benefits when you obtain your covered dental services from a dentist, or a hygienist who is employed by the dentist, who is a preferred dentist. These are called your in-network benefits. (Your Benefits Payable Riders that are part of your Dental Blue Freedom Benefit Description describe your in-network benefit level and cost-share amounts for these covered dental services.)

Preferred Dentist means: a dentist who has a written payment agreement to furnish covered dental services to members enrolled under a Dental Blue PPO plan. This includes: a dentist who has a PPO payment agreement with Blue Cross and Blue Shield; or a dentist who has a payment agreement with Blue Cross and Blue Shield of Rhode Island; or a dentist outside Massachusetts and Rhode Island who has an agreement to participate in the Blue Cross and Blue Shield designated out-of-area dental network.

Provider Directory. At the time you enroll in Dental Blue Freedom, your group will supply you with a dental provider directory for your location. To find out if a dentist is a preferred dentist, you may look in the dental provider directory that is applicable for your location. Or for help, you may call the Blue Cross and Blue Shield customer service toll-free telephone number that is shown on your Dental Blue Freedom identification card. You may also use the online dental provider directories that are located on the Blue Cross and Blue Shield internet website at www.bluecrossma.com.

Out-of-Network Benefits

You also have the option to seek covered dental services from a dentist, or a hygienist who is employed by the dentist, who is not a preferred dentist (“non-preferred dentist”). When you obtain covered dental services from a non-preferred dentist, or a hygienist who is employed by the non-preferred dentist, you will usually receive a lower level of benefits. In this case, your out-of-pocket costs will be more. These are called your out-of-network benefits. (Your Benefits Payable Riders that are part of your Dental Blue Freedom Benefit Description describe your out-of-network benefit level and cost-share amounts for these covered dental services.) There are certain situations when in-network benefits will be provided for covered dental services even when they are furnished by a non-preferred dentist. These situations include:

  • You receive emergency care. (This is limited to palliative and/or temporary services. It does not include permanent fillings, root canals, bridges or permanent crowns.)
  • You receive covered specialized services that are not reasonably available from a preferred dentist and you received prior approval from Blue Cross and Blue Shield for those services.

Non-Preferred Dentist means: a dentist who has a Blue Cross and Blue Shield participating provider payment agreement but not a PPO provider contract; or a dentist who does not have a payment agreement with Blue Cross and Blue Shield or Blue Cross and Blue Shield of Rhode Island; or a dentist who is not part of the Blue Cross and Blue Shield designated out-of-area dental network.