Common use of Non-Participating Dentists Clause in Contracts

Non-Participating Dentists. When you receive covered services from a Non- Participating Dentist, you will be reimbursed up to the applicable percentage as specified in the Blue Shield of California Payment Percentage section in the Summary of Benefits. You will be responsible for the remaining percentage amount plus the remainder of the Dentist’s billed charges. You should discuss this beforehand with your Dentist if he is not a Participating Dentist. Any difference between a contracted Dental Plan Administrator’s or Blue Shield of California’s payment and the Non-Participating Dentist's charges are your responsibility. Subscribers are expected to follow the billing procedures of the dental office. If your receive covered Services from a Non-Par- ticipating Dentist, either you or your provider may file a claim using the dental claim form which may be obtained by calling Dental Cus- tomer Services at: 0-000-000-0000 Claims for all Services rendered by Non-Partici- pating Dentists, should be sent to: Blue Shield of California P O Box 272590 Chico, CA95927-2590 Calendar Year Deductible per person

Non-Participating Dentists. When you receive covered services from a Non- Participating Dentist, you will be reimbursed up to the applicable percentage as specified in the Blue Shield of California Payment Percentage section in the Summary of Benefits. You will be responsible for the remaining percentage amount plus the remainder of the Dentist’s billed charges. You should discuss this beforehand with your Dentist if he is not a Participating Dentist. Any difference between a contracted Dental Plan AdministratorAd- ministrator’s or Blue Shield of California’s payment pay- ment and the Non-Participating Dentist's charges are your responsibility. Subscribers are expected to follow the billing procedures of the dental officeof- fice. If your receive covered Services from a Non-Par- ticipating Non- Participating Dentist, either you or your provider may file a claim using the dental claim form which may be obtained by calling Dental Cus- tomer Services at: 0-000-000-0000 Claims for all Services rendered by Non-Partici- pating Non- Participating Dentists, should be sent to: Blue Shield of California P O Box 272590 ChicoXxxxx, CA95927CA 95927-2590 Calendar Year Deductible per person