Benefits for covered services by a non-participating dentist outside of Massachusetts are provided based on usual and customary charges. The allowed charge is based on a schedule of charges established by BCBS. You may be responsible for any difference between the dentist’s actual charge or the allowed charge, whichever is less. You are also responsible for your deductible and coinsurance (if applicable), and charges beyond your calendar-year maximum.
Out-of-Network dentists do not have contracts with Blue Cross Blue Shield. Blue Cross Blue Shield will reimburse you the percent listed on the chart of the usual and customary charges.