Orthodontic Treatment Plan Down Payment Sample Clauses

Orthodontic Treatment Plan Down Payment. − If orthodontic treatment is provided by a Delta Dental PPO Participating Dentist, payment shall be made by DDPOK to a Delta Dental PPO Participating Dentist at the rate of fifty percent (50%) of the amount equal to one−third (1/3) of the Delta Dental PPO Participating Dentist’s estimated total treatment plan fee or fifty percent (50%) of the amount equal to one−third (1/3) of the maximum allowable amount for Delta Dental PPO Participating Dentists, whichever is less, subject to the maximum orthodontic benefit payment and treatment plan. The Subscriber shall be responsible for paying the Delta Dental PPO Participating Dentist any amount of the orthodontic treatment plan down payment that is not discharged by the DDPOK payment. In the event the Dentist providing orthodontic treatment has not signed a Delta Dental PPO Participating Dentist Agreement but has signed a Delta Dental Premier Participating Dentist Agreement, payment shall be made by DDPOK to a Delta Dental Premier Participating Dentist at the rate of fifty percent (50%) of the amount equal to one−third (1/3) of the Delta Dental Premier Participating Dentist’s estimated total treatment plan fee or fifty percent (50%) of the amount equal to one−third (1/3) of the maximum allowable amount for Delta Dental Premier Participating Dentists, whichever is less, subject to the maximum orthodontic benefit payment and treatment plan. The Subscriber shall be responsible for paying the Delta Dental Premier Participating Dentist any amount of the orthodontic treatment plan down payment that is not discharged by the DDPOK payment. In the event the Dentist providing orthodontic treatment has not signed a Participating Dentist Agreement, payment shall be made by DDPOK to the Subscriber, or to other participant or beneficiary if required by law, at the rate of fifty percent (50%) of the amount equal to one−third (1/3) of the Nonparticipating Dentist’s estimated total treatment plan fee or fifty percent (50%) of the amount equal to one−third (1/3) of the prevailing fee, whichever is less, subject to the maximum orthodontic benefit payment and treatment plan. The Subscriber shall be responsible for paying the Nonparticipating Dentist both the payment received from DDPOK for the orthodontic treatment plan down payment and any amount of the Nonparticipating Dentist’s required down payment that is not discharged by the DDPOK payment.
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