Services Not Dentally Necessary. This agreement does NOT cover services to identify or treat your dental or oral health conditions that are NOT dentally necessary in accordance with our dental policies and related guidelines (See Section 8.0 β Glossary). We will use any reasonable means to make a determination about the dental necessity of your care. We may examine dental records. We review dental necessity in accordance with our dental policies and related guidelines. You have the right to appeal our determination or to take legal action as described in Section 7.0. We may deny payments if a dentist does not supply dental records needed to determine dental necessity. We also may deny or reduce payment if the records sent to us do not provide adequate justification for performing the service. This agreement does NOT cover orthodontic services that are NOT medically necessary in accordance with our dental policies and related guidelines (See Section 8.0 β Glossary).
Appears in 4 contracts
Samples: Subscriber Agreement, Subscriber Agreement, Subscriber Agreement
