Dentist Friendly Provider Agreement

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DENTAL PROVIDER AGREEMENT FOR GENERAL DENTISTRY
This Agreement is made and entered into today by and between the user (hereinafter referred to as DENTIST) who is licensed to practice Dentistry in your State and DENTIST FRIENDLY, LLC., a Delaware Limited Liability Corporation (hereinafter Referred to as DENTIST FRIENDLY). Whenever mentioned herein, the term DENTIST shall include all employees of DENTIST, all partners, dental associates, and all staff personnel under his direct supervision and/or control.
WITNESSETH
A. DENTIST FRIENDLY has provided various individuals and groups with a wide range of dental care services on a discount fee for service basis to Subscribers and their eligible dependents participating in DENTIST FRIENDLY.
B. Each of the Subscribers has entered into contracts with DENTIST FRIENDLY by the terms of which contracts DENTIST FRIENDLY has agreed to provide such Subscribers with dental care in exchange for periodic payments (hereinafter referred to as subscription dues) by such Subscribers.

It is specifically understood by the parties hereto that the said contracts contain varying provisions, and also that they may be modified prospectively from time to time. Now, therefore, in consideration of the mutual covenants herein contained and for other good and valuable consideration, it is agreed as follows:

AGREEMENT
1. Rendition of Care:
DENTIST agrees to render all necessary dental Service to each of the Subscribers covered by DENTIST FRIENDLY, during his regular office hours, subject to prior appointments; provided, however that DENTIST shall have the right within the framework of professional ethics to reject any patient seeking his professional services. If DENTIST rejects any Subscriber patient, that patient will have the right to choose another participating DENTIST. In such case, copies of all dental records will be transferred on request of Subscriber to the new participating DENTIST.

2. Eligibility: Evidence of coverage shall be issued to each Subscriber in a form of a membership card by DENTIST FRIENDLY.

3. Fees Due Directly From Subscribers: DENTIST agrees to look solely to the Subscriber for payment of services. Payment for such services shall be billed by DENTIST, at a rate not to exceed the amount (s) set forth in the fee schedules attached, less any amount paid by the group or such other insurance or other benefits covering said patients. If such services are not listed on the attached schedules, then DENTIST shall charge 20% less of his usual and customary fee therefor.

4. Change In Terms And Benefits: It is specifically understood that the benefits, terms and conditions of the various agreements between the Subscribers, DENTIST FRIENDLY, and the DENTIST may be changed from time to time during the term of the Agreement. DENTIST FRIENDLY agrees to notify DENTIST in writing of the nature and extent of such changes. Unless within thirty (30) days after receipt of such notifications, DENTIST notifies DENTIST FRIENDLY in writing that he declines to provide dental services to the Subscribers involved in accordance with the new agreements, DENTIST agrees to continue to perform dental services under the modified agreements, and this Agreement shall be deemed amended accordingly.

5. Duration Of Agreement: This agreement shall continue in effect until terminated by either party, effective (60) days after written notice of intention to terminate is sent by registered or certified mail. Such termination shall have no effect upon the rights and obligations of the parties arising out of any transaction occurring prior to the effective date of such termination and any continuing obligations after termination as set forth herein. In the event of the termination of this Agreement, DENTIST shall complete all work started prior to the termination including full or partial dentures when an impression has been taken. In the event that it is determined by DENTIST FRIENDLY that DENTIST is causing harm to patients, this agreement may be terminated immediately, regardless of amount and nature of outstanding work.

The resignation of a participating DENTIST shall not as to a Subscriber, whose contract is in force at the date of resignation, become effective until the end of such Subscribers contract year.

6. Standard Of Care: DENTIST agrees that he shall perform his obligations under this Agreement in accordance with high standards of competence, care and concern for the welfare and needs of the Subscribers, and in accordance with the principles of ethics of the American Dental Association and the dental practice laws of your state. DENTIST will cooperate with the DENTIST FRIENDLY Quality Assurance Program, Grievance Procedure, in maintaining medical histories, financial and utilization of service data and other records pertaining to Subscribers as shall be requested by DENTIST FRIENDLY. The DENTIST further agrees to allow the Department of Health or any external review entity designated by the Department of Health access to subscriber treatment records for quality assurance or member grievance investigation. It is understood that the records of Subscribers shall be treated as confidential so as to comply with all federal and state laws and regulations regarding the confidentiality of patient records.

7. Non-Exclusive: This agreement is not exclusive in any respect, and DENTIST FRIENDLY is entitled to enter into similar contracts with other dentists. DENTIST is entitled to enter into similar contracts with other parties, or with other groups not represented by DENTIST FRIENDLY, and to maintain his private practice.

8. Dentist Patient Relationship: DENTIST shall maintain the Dentist-Patient relationship with Subscribers to DENTIST FRIENDLY and shall be solely responsible to the patient for dental advice and treatment. It is expressly agreed between the parties that DENTIST is an independent contractor and that neither Subscriber nor DENTIST FRIENDLY shall have any control over DENTIST practice, the DENTIST-Patient relationship, his personnel or facilities.

9. Malpractice: DENTIST agrees to carry Malpractice Insurance in an amount not less than $1.000.000 per occurrence and $3,000,000 annual aggregate; and DENTIST shall provide DENTIST FRIENDLY and/or Group covered hereunder with a Certificate of Insurance providing for 10 days notice of cancellation, as evidence of compliance with this paragraph.

10. Notice To Subscriber On Termination Of Agreement: In the event that this Agreement is terminated by either party, in accordance with the procedure set forth herein, DENTIST agrees that at the time the subscriber seeks an appointment he will notify each Subscriber, prior to giving service, that the contract is no longer in effect. In the event such notice is not given to the Subscriber, DENTIST agrees to accept payment for his services at a rate no more than that set forth in the appropriate Fee Schedules attached hereto.

11. Assignability of Agreement: This Agreement, being intended to secure the personal services of DENTIST and dentists associated with DENTIST shall not be assigned or transferred, without the written consent of DENTIST FRIENDLY.

12. Indemnification: DENTIST FRIENDLY shall not be liable for any act or omission by DENTIST. In connection with or arising solely out of the negligent performance of dental services by DENTIST, DENTIST agrees to defend, indemnify and hold DENTIST FRIENDLY harmless from any claims, demands, liabilities, damages, or judgments against DENTIST FRIENDLY and its agents.

FREQUENTLY ASKED QUESTIONS
Q. Does it cost anything to join?
No, there is no charge to participate in the Dentist Friendly Preferred Network.
Q. How will patients know I participate with Dentist Friendly?
Our Customer Service Dept can make active referrals to your office. Members also have access to our online and printed directories.
Q. Can I add an associate to my practice?
Yes, new associates can be added to your practice. Simply have them follow the same easy sign up process.
Q. I need a copy of my fee schedule, how do I get one?
Please contact us directly and we will be happy to provide you with copies of your contract and fee schedule.
Q. Large Group Practice?
If your practice consists of 10 offices or more, your sign up process can be simplified. You will be assigned a designated representative to assist you with your contracting needs. A single point of contact will alleviate any confusion when contracting multiple dentists and locations.