preauthorized by us. You pay the specified Copayment. (Refer to Schedule A.)
SPECIALIST SERVICES PERFORMED BY AN OUT-OF-NETWORK SPECIALIST THAT ARE NOT PREAUTHORIZED MAY NOT BE COVERED.
If the services of a Contract Orthodontist are needed, please refer to Section XI, Orthodontics, in Schedule A and Schedule B, Orthodontic Limitations and Exclusions to determine Benefits.
