Our Right to Conduct Utilization Review. To be sure a member receives appropriate benefits; we reserve the right to conduct utilization review. We also reserve the right to contract with an organization to do utilization review on our behalf. If another company does utilization review on our behalf, the company will act as an independent contractor. The company is not a partner, agent, or employee of Blue Cross & Blue Shield of Rhode Island. This agreement provides coverage only for dentally necessary care. The determination, by an entity conducting utilization review, whether a service is dentally necessary is solely for the purpose of claims payment and the administration of your dental benefit plan. It is not a professional dental judgment. Although we may conduct utilization review, Blue Cross & Blue Shield of Rhode Island does not act as a dentist. We do not furnish dental care. We do not make dental judgments. You are not prohibited from having a treatment for which reimbursement has been denied. Nothing here will change or affect your relationship with your dentist(s).
Appears in 11 contracts
Samples: Subscriber Agreement, Subscriber Agreement, Subscriber Agreement
Our Right to Conduct Utilization Review. To be sure a member receives appropriate benefits; we reserve the right to conduct do utilization review. We also reserve the right to contract with an organization to do utilization review on our behalf. If another company does utilization review on our behalf, the company will act as an independent contractor. The company is not a partner, agent, or employee of Blue Cross & Blue Shield of Rhode Island. This agreement provides coverage only for dentally necessary care. The determination, by an entity conducting utilization review, whether a service is dentally necessary is solely for the purpose of claims payment and the administration of your dental benefit plan. It is not a professional dental judgment. Although we may conduct utilization review, Blue Cross & Blue Shield of Rhode Island does not act as a dentist. We do not furnish dental care. We do not make dental judgments. You are not prohibited from having a treatment for which reimbursement has been denied. Nothing here will change or affect your relationship with your dentist(s).
Appears in 1 contract
Samples: Subscriber Agreement
