Common use of Allowable Charge Clause in Contracts

Allowable Charge. To take full advantage of the negotiated pricing arrangements in effect between Blue Cross and Blue Shield of Oklahoma and our network of Participating Dentists, you should use Participating Dentists whenever possible. Participating Dentists have agreed to hold the line on dental care costs by providing special prices for our Subscribers. A Participating Dentist will accept this negotiated price (called the “Allowable Charge”) as payment for Covered Services. This means that, if a Participating Dentist bills you more than the Allowable Charge for Covered Services, you are not responsible for the difference. The Plan will calculate your Benefits based on this “Allowable Charge”. We will deduct any charges for services which aren’t eligible under your coverage, then subtract your Deductible and/or Coinsurance amounts which may be applicable to your Covered Dental Services, as set forth in the Schedule of Benefits. We will then determine your Benefits under this Contract and direct any payment to your Participating Dentist. If you use an Out-of-Network Dentist, you will be responsible for the following: • Charges for any services which are not covered under your Contract; • Any Deductible and/or Coinsurance amounts which are applicable to your coverage; and • The difference, if any, between your Dentist's “billed charges” and the “Allowable Charge”. Your coverage may include a higher Deductible and/or Coinsurance percentage for services you receive from an Out-of-Network Provider (check the Schedule of Benefits issued with this Contract). Some Benefits are limited to a specific dollar amount or number of services or visits allowed during a Benefit Period. Your Benefit Period is a Calendar Year, which begins on January 1st and ends on December 31st of the same year. The initial Benefit Period begins on your Effective Date and ends on December 31st, which may be less than 12 months. Your Policy Year and Benefit Period run concurrently.