12005

Member for

7 years 1 month
Submitted by Site Factory admin on
Dental services to repair and/or replace sound natural teeth damaged due to an accidental injury, but only when the dental services are furnished within 18 months following the accident. These benefits include treatment to repair or replace damaged teeth, dental prosthetics (such as implants, dentures, bridges, braces, and other such dental appliances) that are necessary to restore damaged teeth to a permanent level of restoration, and necessary follow-up medical and/or dental services to restore the member's condition to the same level as before the accidental injury. (When these covered services are furnished by a licensed dentist who does not participate in the PPO health care network, in-network benefits will be provided. In this situation, Blue Cross and Blue Shield will use the dentist's charge up to the usual and customary charge to calculate the claim payment. The usual and customary charge is based on the 90th percentile of the Dental Prevailing Health Care Charges in the zip code region where the services are furnished. This usual and customary charge may sometimes be less than the dentist's actual charge. If this is the case, the member will be responsible for the amount of the non-preferred dentist's actual charge that is in excess of the usual and customary charge.)