Dental Services Not Covered

The following expenses are not covered:

  • Services, supplies, procedures or appliances to treat an illness or injury for which you have the right to benefits under government programs. These include the Veterans Administration for an illness or injury connected to military service. They also include programs set up by other local, state, federal or foreign laws or regulations that provide or pay for health care services and supplies or that require care or treatment to be furnished in a public facility. No benefits are provided if you could have received governmental benefits by applying for them on time. This exclusion does not include Medicaid or Medicare.
  • Charges that are received for or related to dental care that Blue Cross and Blue Shield considers to be experimental. The care must be documented by controlled studies that determine its merits (such as its safety) and include sufficient follow-up studies.
  • Charges for appointments that you do not keep. Dentists may charge you for failing to keep your scheduled appointments. They may do so if you do not give reasonable notice to the office. Appointments that you do not keep are not counted against any benefit limits described in this BU Dental Health Center Plan Benefit Description.
  • A service, supply, procedure or appliance that is not described as a covered dental service in the BU Dental Health Center Plan Benefit Description
  • Services, supplies, procedures or appliances that do not conform to Blue Cross and Blue Shield dental policy guidelines
  • Any service or supply furnished along with, in preparation for, or as a result of a non-covered dental service
  • Services, supplies, procedures and appliances that are not considered necessary and appropriate by Blue Cross and Blue Shield
  • Services, supplies, procedures and appliances that are furnished to someone other than the patient
  • Treatment and related services that are required by third parties
  • Free care or care for which you are not required to pay or for which you would not be required to pay if you were not covered under the BU Dental Health Center Plan
  • Nutrition counseling or instructions in dental hygiene, including proper methods of tooth brushing, the use of dental floss, plaque control programs and caries (cavity) susceptibility tests
  • Incomplete procedures
  • Laboratory or bacteriological tests
  • Consultations when the dentist who renders the consultation provides treatment
  • Restorations for reasons other than decay or fracture of teeth, such as erosion, abrasion or attrition
  • Sealants applied to permanent premolar or molar surfaces that have decay or fillings
  • Fillings on tooth surfaces where a sealant was applied within the last 12 months
  • Replacement of a filling within 12 months of the date of the prior restoration
  • Stainless steel crowns on permanent (adult) teeth, other than on first permanent (adult) molars for members under age 16
  • Fixed or removable prosthodontics or major restorative procedures for members under age 16. (The BU Dental Health Center Plan provides the benefit for a temporary partial denture for replacement of a lost or missing tooth. You pay any balance.)
  • Temporary complete dentures or temporary fixed bridges
  • Replacement of dentures, bridges or space maintainers for reasons such as theft, abuse, misuse, misplacement, loss, improper fit, allergies, breakage or ingestion
  • Duplicate dentures or bridges
  • Transplants or any related surgical or restorative procedures
  • Any procedure to save a tooth when there is a poor statistical probability (less than a 70% chance) that the tooth will last for 60 months (for example, surgical periodontal regenerative procedures to stabilize a tooth loosened due to extensive periodontal disease)
  • Cast restorations, copings or attachments for installing overdentures, including associated endodontic procedures such as root canals
  • Precision attachments, semiprecision attachments or copings
  • A service to diagnose or treat temporomandibular joint (TMJ) disorders or myofascial (muscular) pain, including bruxism (grinding of the teeth)
  • A service, supply or procedure when its sole purpose is to increase the height of teeth (vertical dimension) or to restore occlusion
  • A separate charge for occlusal analysis, pulp vitality testing or pulp capping since these services are usually performed as part of another covered procedure
  • Drugs, pharmaceuticals, biologicals or other prescription agents or products
  • Photographs
  • A dentist’s charge to file a claim. Also, a dentist’s charge to transcribe or copy your dental records
  • Services and supplies furnished before your effective date, except for a multi-stage procedure that begins before your effective date and is completed date while you are enrolled under the BU Dental Health Center Plan. See “Multi-Stage Dental Procedures” above
  • Services and supplies furnished after your termination date under the BU Dental Health Center Plan. (If your membership under the BU Dental Health Center Plan is terminated prior to the completion date of a procedure that requires more than one visit, no benefits are provided for the entire procedure.)