How do you pay participating offices vs non–participating offices?
If you see a participating office, payment will be based on the provider’s fee on file they have with their local member company. If you see an out–of–network dentist, the fees will be based upon the plan allowance in that dentist’s geographic location. The plan allowance is an amount that satisfies the majority of dentists’ fees in the dentist’s geographic location. If the dentist charge is more than the plan will allow (or the coverage in the area), the extra cost will be the responsibility of the subscriber.
