IN NETWORK. If my treating dentist is in-network with my dental insurance plan, I will be billed pursuant to the terms of my insurance policy and my dentist’s contract with the insurer. Even when the practice and my treating dentist are a participating provider with my insurance, I understand that the practice may hold me responsible and collect all charges in any one of the following situations: ● When I choose to have a service that my dental plan covers but I do not obtain the required referral or prior authorization from my health plan. ● When I choose not to use my dental plan and agree to pay for services myself. ● When I receive services that are not covered under my dental plan
Appears in 21 contracts
Samples: General Consent Agreement, General Consent Agreement, General Consent Agreement