Financial Responsibility for Continuity of Care Services Sample Clauses

Financial Responsibility for Continuity of Care Services. If a Person is entitled to receive Services from a terminated provider under the preceding Xxxxx- nuity of Care provision, the responsibility of the Person to that provider for Services rendered un- der the Continuity of Care provision shall be no greater than for the same Services rendered by a Participating Dentist in the same geographic area.

Financial Responsibility for Continuity of Care Services. If a Member is entitled to receive Services from a terminated provider under the preceding Continuity of Care provision, the responsibility of the Member to that provider for Services rendered under the Continuity of Care provision shall be no greater than for the same Services rendered by a Preferred Provider in the same geographic area. Monthly Dues are as stated in the Appendix. Blue Shield of California offers a variety of options and methods by which you may pay your Dues. Please call Customer Service at the telephone number indicated on your Identification Card to discuss these options or visit the Blue Shield of California internet site at xxxx://xxx.xxxxxxxxxxxx.xxx. Payments by mail are to be sent to: Blue Shield of California P.O. Box 51827 Los Angeles, CA 90051-6127 Additional Dues may be charged in the event that a State or any other taxing authority imposes upon Blue Shield of Cali- fornia a tax or license fee which is calculated upon base dues or Blue Shield of California's gross receipts or any portion of either. Dues increase according to the Subscriber's age, as described in the Appendix. Dues may also increase from time to time as determined by Blue Shield of California. You will receive 60 days written notice of any changes in the monthly dues for this plan. The benefits of this Plan, including but not limited to Covered Services, Deductible, Copayment, and annual copayment maximum amounts, are subject to change at any time. Blue Shield will provide at least 60 days written notice of any such change. Benefits for Services or supplies furnished after the Effective Date of any change in benefits will be based on the change. There is no vested right to obtain benefits.

Financial Responsibility for Continuity of Care Services. If a Member is entitled to receive Services from a terminated provider under the preceding Continuity of Care provision, the responsibility of the Member to that provider for Services rendered under the Continuity of Care provision shall be no greater than for the same Services rendered by a Participating Dentist in the same geographic area. Before any course of treatment expected to cost more than $250 is started, you should obtain Pre-certification of Benefits. Your Dentist should submit the recommended treatment plan and fees together with appropriate diagnostic X-rays to a contracted Dental Plan Administrator. A contracted Dental Plan Administrator will review the dental treatment plan to determine the benefits payable under the plan. The benefit determination for the proposed treatment plan will then be promptly returned to the Dentist. When the treatment is completed, your claim form should be submitted to a contracted Dental Plan Administrator for payment determination. A contracted Dental Plan Administrator will notify you of its determination within 30 days after receipt of the claim. The dental plan provides benefits for covered services at the most cost-effective level of care that is consistent with professionally recognized standards of care. If there are two or more professionally recognized procedures for treatment of a dental condition, this plan will in most cases provide benefits based on the most cost-effective procedure. The benefits provided under this plan are based on these considerations but you and your Dentist make the final decision regarding treatment. Failure to obtain Pre-certification of Benefits may result in a denial of benefits. If the Pre-certification process is not followed, a contracted Dental Plan Administrator will still determine payment by taking into account alternative procedures; services or materials for the dental condition based on professionally recognized standards of dental practice. However, by following the Pre-certification process both you and your Dentist will know in advance which services are covered and the benefits that are payable. The covered dental expense will be limited to the Allowable Amount for the procedure, service or material which meets professionally recognized standards of quality dental care and is the most cost effective as determined by a contracted Dental Plan Administrator. If you and your Dentist decide on a more costly procedure, service or material than a contracted Dental Pl...