Managed Care. The County may offer the services of a managed care program to unit members. The parties agree to prepare a brochure comparing and describing the benefits of managed care and jointly encourage its use by unit members. Participation in a selection from the Managed Care preferred provider physicians’ list shall be voluntary. The County and the Union will encourage employees incurring job related injuries to work cooperatively with nurse advisors who operate under the Managed Care case management system. To this end, the parties acknowledge the goal of the case management system is to assist the employee in obtaining maximum medical improvement in order to return to work at the earliest possible opportunity. The managed care program will have the following components:
Managed Care. Managed vision care networks that meet standards developed by the National Carriers' Conference Committee concerning quality of care, access to providers and cost effectiveness shall be established wherever feasible. Employees who live in a geographical area where a managed vision care network has been established will be enrolled in the network along with their covered dependents. Employees enrolled in a managed vision care network will have a point-of-service option allowing them to choose an out-of-network provider to perform any vision care service covered by the Plan that they need. The benefits provided by the Plan when services are performed by in-network providers will be greater than the benefits provided by the Plan when the services are performed by providers who are not in- network providers, including providers in geographic areas where a managed vision care network has not been established. These two sets of benefits will be as described in the table below. Plan Benefit In-Network Other Than In-Network One vision examination per 12- month period. 100% of reasonable and customary charges 100% of reasonable and customary charges up to a $35 maximum One set of frames of any kind per 24-month period 100% of reasonable and customary charges1 100% of reasonable and customary charges up to a $35 maximum One set of two lenses of any kind, including contact lenses, per 24-month period. 100% of reasonable and customary charges2 100% of reasonable and customary charges up to the following maximums: up to $25 for single vision lenses up to $40 for bifocals up to $55 for trifocals up to $80 for lenticulars up to $210 for medically necessary contact lenses up to $105 for 1 Patients who select frames that exceed a wholesale allowance established under the program may be required to pay part of the cost of the frames selected.
Managed Care. If you are enrolled in a managed care insurance plan (i.e. HMO), you must have a current referral from your primary care physician’s office to see a specialist (Pediatric Consultants patients). We will be unable to see you if you do not have a referral at the time service is rendered. It is your responsibility to ensure that all of your referrals are up to date. FORM FEE CHARGES: Please see our website (xxx.xxxxx.xxx) for fees associated with forms. MISSED APPOINTMENTS/LATE CANCELLATIONS: Missed appointments represent a cost to us, to you, and to other patients who could have been seen in the time set aside for you. Cancellations are requested 24 hours prior to the appointment. We reserve the right to charge for missed appointments or appointments not cancelled within 24 hours. Effective February 27, 2017, the charge for missed appointments is $25 for a single missed appointment Monday through Friday 8:30 a.m. to 5 p.m. and $50 for a single missed appointment during our extended hours 7 a.m. to 8:30 a.m. Monday through Friday, and for all Saturday appointments. The missed appointment fee will be $100 for double appointments and $150 for triple appointments that are not cancelled within 24 hours. Excessive abuse of scheduled appointments may result in discharge from the practice. MEDICAL SUPPLIES: If the practice orders any medical supplies or products related to the scheduled appointment with a provider in our office, the patient and/or the guarantor will be responsible for the cost of the supplies/products in addition to the fee imposed for missed appointments/late cancellations. SELF PAY: Under HIPAA, the Pay out of Pocket Provision states:
Managed Care. This section tells you about HPN’s Managed Care Program and which Covered Services require Prior Authorization.
Managed Care. Shire shall use commercially reasonable efforts to maintain the Shire Product on formularies of managed care customers consistent with the inclusion thereon of the Shire Product as of the Effective Date of this Agreement. The current formulary positions for the Shire Product are attached as Schedule 7.
Managed Care. Managed vision care networks that meet standards developed by the National Carriers' Conference Committee concerning quality of care, access to providers and cost effectiveness shall be established wherever feasible. Employees who live in a geographical area where a managed vision care network has been established will be enrolled in the network along with their covered dependents. Employees who live in a geographical area where a managed vision care network has been established will be enrolled in the network along with their covered dependents. Employees enrolled in a managed vision care network will have a point-of-service option allowing them to choose an out-of-network provider to perform any vision care service covered by the Plan that they need. The benefits provided by the Plan when services are performed by in-network providers will be greater than the benefits provided by the Plan when the services are performed by providers who are not in-network providers, including providers in geographic areas where a managed vision care network has not been established. These two sets of benefits will be as described in the table below. Other Than Plan Benefit In-Network In-Network One vision 100% of reasonable 100% of reasonable examination per 12- and customary and customary month period. charges charges up to a $35 maximum One set of frames of 100% of reasonable 100% of reasonable any kind per 24- and customary and customary month period charges1 charges up to a $35 maximum One set of two 100% of reasonable 100% of reasonable lenses of any kind, and customary and customary including contact charges2 charges up to the lenses, per 24-month following maximums: period. up to $25 for single vision lenses up to $40 for bifocals up to $55 for trifocals up to $80 for lenticulars up to $210 for medically necessary contact lenses up to $105 for contact lenses that are not medically necessary Where the employee 100% of reasonable 100% of reasonable or dependent and customary and customary requires only one charges 2/ charges up to a lens maximum of one-half of the maximum benefit payable for a set of two lenses of the same kind 1 Patients who select frames that exceed a wholesale allowance established under the program may be required to pay part of the cost of the frames selected.
Managed Care. This section tells you about SHL’s Managed Care Program and which Covered Services require Prior Authorization.
Managed Care. The Parties shall coordinate activities with respect to Product across managed care market segments in the Field in the Co-Promotion Territory including: (i) contract strategy, (ii) contract creation; (iii) government reporting, rebate processing, calculations and pricing schedules; (iv) contract compliance, monitoring and audits; (v) contract administration and claims processing; and (vi) all other matters related to managed care. [***] to Detail or otherwise Commercialize Product to any Physician Targets or to any contracting agents, medical directors, formulary decision makers, benefit managers, or administrators (even if such persons are health care professionals legally authorized to prescribe Product) of a managed care organization (e.g., health maintenance organization, prescription benefits manager, insurance company, or similar entity), government-funded insurance or medical program, or employer. All Product Commercialization and contracting activities with managed care entities will be conducted by the designated Party.
Managed Care. Salix shall be solely responsible for all aspects of managed care in connection with the Product, including, without limitation: (a) contract strategy, (b) contracting, (c) contract administration and claims processing, (d) contract compliance, monitoring and auditing, (e) account management, including P&T committee presentations, and (f) government reporting, government program, rebate processing, FSS calculations and pricing schedules. Salix shall communicate with Altana sales management on a quarterly basis regarding such managed care activities.
Managed Care. AstraZeneca shall be responsible for managing necessary responsibilities with respect to the Co-Promoted Products across all managed care market segments in the Co-Promotion Territory and shall have exclusive responsibility for: (i) contract strategy, (ii) contract creation; (iii) government reporting, rebate processing, FSS calculations and pricing schedules; (iv) contract compliance, monitoring and audits; (v) contract administration and claims processing; and (vi) all other matters related to managed care.
