Navigating Blue Cross Blue Shield Dental Plans for Federal Employee Patients

Gain insights into the intricacies of dental coverage for federal employees insured under Blue Cross Blue Shield. This guide breaks down the FEP Blue Focus, FEP Basic Option, and FEP Standard Option plans, providing dental offices with a comprehensive understanding of the limited yet critical dental services covered. Explore the primary role these plans play in the complex landscape of federal employee insurance.

Understanding the dental coverage landscape for federal employees insured under Blue Cross Blue Shield is essential for dental offices. These patients are enrolled in plans that come with specific dental riders, influencing the scope of services covered. Let's delve into the key points of the FEP Blue Focus, FEP Basic Option, and FEP Standard Option plans.

FEP Blue Focus Plan:

This plan places emphasis on healthcare services other than routine dental visits. Patients enrolled in the FEP Blue Focus Plan do not have coverage for routine dental services. Dental offices should be aware that their services may not be covered under this plan, and patients may seek routine dental care elsewhere.

FEP Basic Option Plan:

Dental offices dealing with patients under the FEP Basic Option Plan need to be aware of the limited coverage it provides. While it includes some preventative and diagnostic services such as evaluations, X-rays (excluding Panoramic Radiographs D0330), and prophylaxes, certain services like restoratives, periodontics, endodontics, oral surgery, prosthodontics, implants, and orthodontics are not covered. Additionally, there is a $30 co-payment per evaluation, and benefits are only payable when services are provided by a provider contracted specifically with the Blue Cross Blue Shield FEP Basic option network.

FEP Standard Option Plan:

Similar to the Basic Option, the FEP Standard Option Plan offers limited preventative and diagnostic services. Dental offices should note the restrictions on services like restoratives, periodontics, endodontics, oral surgery, prosthodontics, implants, and orthodontics. However, the benefit here is that services are covered for both in-network and out-of-network providers, offering more flexibility for patients seeking dental care.

Despite the limitations, these plans take precedence as primary coverage. Dental offices should file claims under these policies, even if a procedure falls outside the coverage but is included in the secondary dental policy held by federal employees. Common secondary dental policies include those provided by Delta Dental Federal, United Concordia, GEHA, Metlife, Aetna, and Humana, offering more comprehensive coverage, sometimes without a maximum cap under high option policies.

This comprehensive guide equips dental offices with the knowledge needed to navigate Blue Cross Blue Shield dental plans for federal employee patients, ensuring informed decision-making in providing dental care.