BCBS FEP Dental offers two plan options – High Option and Standard Option – which provide different levels of coverage for dental procedures. However, it’s important to note that services considered strictly cosmetic in nature are specifically excluded from coverage under both plans.
BCBS FEP Dental Coverage Overview
BCBS FEP Dental provides comprehensive dental coverage through two plan options – High Option and Standard Option – each offering different levels of coverage for dental procedures. Understanding your benefits can help you maximize your coverage and minimize out-of-pocket costs.
Want help understanding your exact coverage and benefits?
Schedule a free insurance verification with our team, and we’ll break down your specific BCBS FEP Dental benefits before you begin treatment.
Network Status
As a dental practice in Honolulu, we work with BCBS FEP Dental’s extensive network to provide you with comprehensive dental care.
When you visit our practice, you’ll benefit from negotiated rates and streamlined claims processing through BCBS FEP Dental’s network benefits.
Our team handles all insurance claims directly, ensuring a seamless experience for our patients.
High Option members have immediate access to benefits with no deductible, while Standard Option members enjoy the advantage of no deductible for in-network services at our practice.
We can also coordinate your BCBS FEP Dental benefits with any additional insurance coverage you may have.
Coverage Limits
For restorative and major dental procedures like implants, crowns, bridges, and All-on-4 treatments, BCBS FEP Dental provides different coverage levels based on your plan:
High Option members receive unlimited annual coverage for in-network services at our practice for Class A, B, and C services. This means there’s no cap on your annual benefits when receiving treatment at our office. For Standard Option members, coverage extends up to $1,500 annually for in-network services.
Coverage determinations are based on dental necessity rather than cosmetic considerations.
Our office will help submit all necessary documentation to BCBS FEP Dental for coverage review and pre-treatment estimates.
Waiting Periods
One of the most beneficial features of BCBS FEP Dental coverage at our practice is that there are no waiting periods for any services. This means you can begin treatment immediately upon your coverage becoming effective, including major procedures like implants, crowns, bridges, and All-on-4 treatments. This immediate access applies to all categories of service:
- Preventive care
- Basic procedures
- Major restorative work
- Complex dental procedures
This feature is particularly advantageous for patients needing extensive dental work or those considering implant-based solutions. Our team can verify your coverage status and help schedule your treatment as soon as you’re ready to begin, without any waiting period restrictions.
What Cosmetic Dental Procedures Does BCBS FEP Dental Cover?
Dental Implants
BCBS FEP Dental provides comprehensive coverage for dental implants when deemed medically necessary. Under the High Option plan, members pay 50% coinsurance with no annual maximum for in-network services. Standard Option members pay 65% coinsurance, subject to the $1,500 annual maximum. Coverage encompasses the complete implant procedure, including the implant body placement, abutment attachment, and final crown restoration. Our office will help document medical necessity and submit pre-treatment estimates to maximize your benefits.
Dental Crowns
Crown coverage through BCBS FEP Dental focuses on restorative needs rather than purely cosmetic purposes. High Option members are responsible for 50% of the covered costs, while Standard Option members pay 65% for in-network services. Coverage applies when crowns are required due to substantial tooth damage, decay, or following root canal therapy. Both porcelain and ceramic crown options are available under the plan’s benefits when meeting medical necessity requirements. Our team will help determine your specific coverage based on your dental needs.
Dental Bridges
Bridge procedures receive similar coverage to other major restorative services under BCBS FEP Dental. High Option members pay 50% coinsurance, and Standard Option members pay 65% for in-network care. The coverage includes all components of the bridge: the pontics (replacement teeth) and the supporting crowns on adjacent teeth. We can help evaluate whether a bridge is the most appropriate and cost-effective solution for your missing teeth, ensuring maximum insurance benefit utilization.
All-On-Four
All-on-4 implant solutions follow BCBS FEP Dental’s guidelines for both implant and prosthetic coverage. The procedure combines multiple implants with a full-arch prosthesis, requiring careful treatment planning to maximize insurance benefits. High Option members pay 50% coinsurance with no annual maximum in-network, while Standard Option members pay 65% up to their annual maximum. Our office strongly recommends obtaining a pre-treatment estimate for All-on-4 procedures to understand coverage and out-of-pocket costs before beginning treatment.
How to Use Your BCBS FEP Dental Insurance at PDIS
Verification Process
Our insurance team conducts a thorough verification of your BCBS FEP Dental benefits before your first appointment. We start by confirming your plan option (High or Standard) and checking your available benefits for the calendar year. For High Option members, we verify your unlimited annual maximum for in-network services, while for Standard Option members, we track your $1,500 annual maximum. Our staff examines specific coverage details for your planned procedures and coordinates with any secondary insurance you may have to maximize your total benefits.
Pre-authorization Requirements
Although BCBS FEP Dental does not mandate pre-authorization for most procedures, our office strongly recommends obtaining pre-treatment estimates for major services. Our experienced team handles the submission process, providing comprehensive documentation including clinical records, necessary radiographs, and detailed treatment plans that demonstrate dental necessity. BCBS FEP Dental typically processes these pre-treatment estimates within 2-3 weeks, giving you a clear understanding of expected coverage and out-of-pocket costs. These estimates remain valid through the current calendar year or for 12 months from issue date, provided you maintain continuous coverage.
Coverage Tiers and Network Details
As an in-network provider with BCBS FEP Dental, we offer significant cost savings through negotiated rates. High Option members receive 100% coverage for preventive services, pay 30% coinsurance for basic services, and 50% for major services with no annual maximum. Standard Option members also get 100% coverage for preventive care, with 45% coinsurance for basic services and 65% for major services, subject to the annual maximum. Our office handles all claims submission and processing directly with BCBS FEP Dental, ensuring a seamless experience for our patients. We work diligently to help you understand your benefits and maximize your coverage for all necessary treatments.
Understanding Your Out-of-Pocket Costs
Deductibles
At PDIS, we help you navigate BCBS FEP Dental’s deductible structure to minimize your out-of-pocket expenses.
High Option members enjoy the advantage of having no deductible for any services, whether in-network or out-of-network.
Standard Option members also benefit from having no deductible when receiving care at our office, as we are an in-network provider.
However, Standard Option members would face a $75 deductible if seeking out-of-network care.
As an in-network practice, we help you avoid these additional costs while ensuring all covered charges are properly applied toward your plan’s annual maximum benefits.
Copayments and Coinsurance
BCBS FEP Dental utilizes a straightforward coinsurance model where members pay a percentage of the allowed amount. When visiting our practice, High Option members can expect to pay:
- No cost for preventive services (Class A)
- 30% coinsurance for basic services (Class B)
- 50% coinsurance for major services (Class C)
- 50% coinsurance for orthodontic services (Class D)
Standard Option members at our practice are responsible for:
- No cost for preventive services (Class A)
- 45% coinsurance for basic services (Class B)
- 65% coinsurance for major services (Class C)
- 50% coinsurance for orthodontic services (Class D)
Annual Maximums
We carefully track your annual benefit usage to help maximize your coverage. High Option members receive an unlimited annual maximum for in-network services at our practice, providing extensive coverage throughout the year for Classes A, B, and C services. Standard Option members have a $1,500 annual maximum for in-network services and $750 for out-of-network care.
For orthodontic treatment, both plans maintain separate lifetime maximums:
- High Option: $3,500 lifetime maximum
- Standard Option: $2,500 lifetime maximum for in-network services
- Standard Option: $1,250 lifetime maximum for out-of-network services
Our staff monitors your benefit usage and helps you plan treatment to optimize your coverage while minimizing out-of-pocket expenses.
Financing Options at PDIS
To help manage out-of-pocket expenses, we offer several payment solutions:
- Flexible payment plans
- Major credit cards accepted
- CareCredit healthcare financing
- Coordination with FSA/HSA accounts
Need help financing your dental work?
Next Steps: Schedule Your Consultation
Ready to use your BCBS FEP Dental benefits at PDIS? Schedule a consultation below. When you visit, please bring along your insurance card and a valid photo ID. We also recommend preparing a list of your dental concerns and bringing any previous dental records you may have available.
Having these materials ready will help us provide the most comprehensive evaluation of your needs and insurance coverage. We look forward to serving you soon!