Common use of Payment Guidelines Clause in Contracts

Payment Guidelines. i. PPO or Premier Providers are not paid any incentive as an inducement to deny, reduce, limit or delay any appropriate service. ii. If you or your Provider files a claim for services more than 12 months after the date you received the services, payment may be denied. If the services were received from a Non-Delta Dental Provider, you are still responsible for the full cost. If the payment is denied because your PPO or Premier Provider failed to submit the claim on time, you may not be responsible for that payment. However, if you did not tell your PPO or Premier Provider that you were covered under this dental plan at the time you received the service, you may be responsible for the cost of that service. iii. This dental coverage is arranged by ▇▇▇▇▇ and administered by Delta Dental. If Delta Dental is unable to pay a dental claim for covered services, AvMed remains responsible for payment of such claim consistent with the terms and conditions of this Contract. iv. If you have any questions about any dental charges, processing policies or how your claim is paid, please contact Delta Dental.