Questions & answers · Dental insurance
What events does Rocky Mountain Hospital and Medical Service, Inc. D.B.A. Anthem Blue Cross and Blue Shield's filed dental insurance policy say it pays for?
AI-drafted from filed documents · reviewed: pendingwhether a specific event is coveredRocky Mountain Hospital and Medical Service, Inc. D.B.A. Anthem Blue Cross and Blue Shield
Rocky Mountain Hospital and Medical Service, Inc. D.B.A. Anthem Blue Cross and Blue Shield's filed dental insurance policy in Colorado (CO) covers periodontal maintenance up to 2 times per calendar year, but only for members who have completed a prior periodontal treatment (surgical or non-surgical) [2]. This includes removal of bacteria from gum pockets, scaling and polishing of teeth, periodontal evaluation, and gum pocket measurements [2]. Basic non-surgical periodontal care includes periodontal scaling and root planing, covered once every 36 months if pocket depth is 4 millimeters or greater, and full mouth debridement, covered once per lifetime [2]. Complex surgical periodontal care is covered once every 36 months per single tooth (or multiple teeth in the same quadrant) if pocket depth is 5 millimeters or greater, but only one of the listed services is covered per period [2]. Orthodontic care is reviewed for dental necessity; if not deemed necessary, it may be covered at the cosmetic orthodontic care rate [1]. This does not appear in these excerpts — check the full policy for other covered services.
Information only — not legal advice. The insurer decides.
These answers quote forms insurers filed with state regulators. Your own policy, its endorsements and your state’s rules control. A filed form may not be the version sold to you.
Where this comes from (2)
[1] Rocky Mountain Hospital and Medical Service, Inc. D.B.A. Anthem Blue Cross and Blue Shield · CO · SERFF ANTV-132368966 · form 13-03271.06 SG 0121 · p. 12 · 31 · Your Dental Benefits
Your Dental Benefits Anthem does not determine whether the dental services listed in this section are medically necessary to treat your specific condition or restore your dentition. There is a preset schedule of dental care services that are covered under this plan. We evaluate the procedures submitted to us on your claim to determine if they are a covered service under this plan. EXCEPTION: Claims for orthodontic care will be reviewed to determine if it was dentally necessary orthodontic care. See the section Orthodontic Care for more information. [If it is determined the care is not dentally necessary orthodontic care, it may be covered at the Cosmetic Orthodontic Care rate. … (excerpt — the filed text continues)
[2] Rocky Mountain Hospital and Medical Service, Inc. D.B.A. Anthem Blue Cross and Blue Shield · CO · SERFF ANTV-134103844 · form 13-03281.06 IND 0125 · p. 15 · 35 · Periodontal Services
Periodontal Services Periodontal Maintenance. Any combination of periodontal maintenance and dental cleanings (see Diagnostic and Preventive Services) is covered 2 times per calendar year. Covered only for members that have completed a previous periodontal treatment (surgical or non-surgical). This procedure includes the following; • removal of bacteria from the gum pocket areas • scaling and polishing of the teeth, • periodontal evaluation • gum pocket measurements Basic Non-Surgical Periodontal Care. These services are to treat diseases of the gums (gingiva) and the bone that supports the teeth. • Periodontal scaling and root planing - covered 1 time per 36 months if the tooth has a pocket depth of 4 millimeters or greater. • Full mouth debridement - covered 1 time per lifetime. Complex Surgical Periodontal Care. These services are surgical services to treat diseases of the gums (gingiva) and the that bone supports the teeth. Only one of the below services is covered per 36 month period per single tooth (or multiple teeth in the same quadrant) and only if the pocket depth of the tooth is 5 millimeters or greater. … (excerpt — the filed text continues)
Drafted by a local AI model from the excerpts above, then checked by rules (citations, no rankings, no “not covered” claims from a partial excerpt). Question id Q0789bcf2. Spotted an error? Tell us.