October 2001: Dental Provisions #17
Regence BlueShield reimbursement
We review our reimbursement levels annually, with changes
effective January 1 of each year. Establishing reimbursement
levels, also referred to as "maximum allowables,"
for Regence BlueShield participating dentists involves
careful consideration of a number of factors:
- Submitted charges by dental providers of same specialty
in similar geographic areas.
- Frequency with which each procedure is performed.
- Consumer price index (CPI).
- Effects of the annual adjustment on the cost of
dental coverage.
Regence BlueShield reimburses based on the lesser of
the maximum allowable or the actual charge (billed amount)
for each procedure. In addition, participating dentists
have agreed not to balance-bill patients for amounts
in excess of our maximum allowable for covered services.
Consequently, using the services of a participating
dental provider helps our members control their out-of-pocket
expenses.
Our members may always see their dental provider of
choice. However, while contract benefit percentages
do not change (i.e., 100/80/50% or 80/80/50%, etc.),
the reimbursement amount for a non-participating dentist
may range from 20%-50% less, depending on the procedure
and/or provider specialty.
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