Balance Billing. In-Network Providers are prohibited from balance billing. In-Network Providers have signed an agreement with us to accept a predetermined allowed amount for Covered Services rendered to a Member. A Member is not liable for fees in excess of the allowed amount for a Covered Service, except what is due under the Contract, e.g., copayments, Deductibles or Coinsurance. Out-of-Network Providers are not under an agreement with Alliant and may xxxx you for fees in excess of the MAC. Non-Covered Services are the sole responsibility of the Member when received from any Provider regardless of network status.
Balance Billing. (1) If you receive emergency services (for which benefits are provided under this contract) because of an emergency medical condition with respect to a visit at an emergency department of a hospital or an independent freestanding emergency department, which is a non-participating provider, then such non-participating provider may not bill you, and may not hold you liable, for any amount for such emergency services which is more than the deductible and coinsurance requirements for such services under this contract.
Balance Billing. In accordance with §1932(b)(6) of the Act and 42 C.F.R. §§ 438.3(k) and 438.230(c)(1)-(2), Provider agrees to, and agrees that any of its Contracted Providers or subcontractors will, hold harmless Enrollee for the costs of Covered Services, except for any applicable Co-payment amount allowed by OHCA. (State Contract §1.16.1.3)
Balance Billing. When a Non-Participating Provider bills You for the difference between the Non-Participating Provider’s charge and the Allowed Amount. A Participating Provider may not Balance Bill You for Covered Services.
Balance Billing. A prohibited practice in which a Member is billed by a Participating Provider for amounts in excess of the reimbursement paid to the Participating Provider under the terms of the Plan or applicable benefit program. See La. R.S. 22:1880.
Balance Billing. Notwithstanding any provisions of the Agreement and Exhibit D, if Company obtains knowledge that Provider has engaged in “Balance Billing” in violation of this Agreement and applicable law, Company may direct Provider to immediately refund such amounts to Members. Any such fine may be offset against payments due to Provider by Company. Company may also report said violations of law to CMS and/or LDI. See La. R.S. 22:1880.
Balance Billing. In accordance with 42 CFR § 447.15, Provider shall accept United’s payment as payment in full except for any applicable cost-sharing requirements under the State Contract, and shall not bill or balance bill Covered Persons for Covered Services provided during the Covered Person’s enrollment period. The collection or receipt of any money, gift, donation or other consideration from or on behalf of a Covered Person for any Covered Service provided is expressly prohibited. Provider agrees to hold Covered Persons harmless for charges for any Medicaid covered service. This includes those circumstances where the Provider fails to obtain necessary referrals, service authorization, or fails to perform other required administrative functions. Should an audit by United or an authorized State or federal official result in disallowance of amounts previously paid to Provider, Provider will reimburse United upon demand. Provider shall not bill Covered Persons in these instances. Provider agrees not to bill Covered Person for Medically Necessary services covered under the State Contract and provided during the Covered Person’s period of enrollment with United. This provision shall continue to be in effect even if United becomes insolvent. If the service is a non-Medicaid covered service, prior to providing the service, Provider shall inform the Covered Person of the non-Medicaid covered service and have the Covered Person acknowledge the information. If the Covered Person agrees in advance of receiving the service and in writing to pay for a non-Medicaid covered service, then the Provider can bill the Covered Person. If United determines a Covered Person was charged for Covered Services inappropriately, such payment may be recovered, as applicable. Provider is subject to criminal penalties if Provider knowingly and willfully charges for any service provided to a Covered Person under the State Plan or covered under the CCCP Contract, money or other consideration at a rate in excess of the rate established by the Department, as specified in section 1128B (d)(1) of the Social Security Act (42 U.S.C. § 1320a-7(b), as amended. This provision shall continue to be in effect even if United becomes insolvent until such time as Covered Persons are withdrawn from assignment to United. Pursuant to section 1932(b)(6), (42 U.S.C. § 1396u-2 (b)(6)), Provider shall not hold a member liable for:
Balance Billing. No claim for payment, except for co-payments, deductibles, and co-insurance, will be made by the Contractor or Provider from the Enrollee for a service covered under this CHIP contract. The Contractor and Provider will not balance bill the Enrollee for dental costs covered under the CHIP contract. The Provider will consider the reimbursement from the Contractor plus co-payments, deductibles, and/or co-insurance as payment in full for dental costs. For costs in excess of the $1,000 benefit limit, Providers shall continue to bill clients at the contracted rate according to the restrictions set forth in Attachment B, section 10.4.2. Clients will have the responsibility to pay those costs only if the requirements of Attachment B, section 10.4.2 are followed.
Balance Billing. (i) Provider shall not, under any circumstances, seek or require any Member to tender a deposit or similar payment during the Member’s course of treatment, or anytime thereafter, with respect to Services rendered pursuant to this Agreement, other than any applicable deductible, encounter fees, coinsurance or copayments specified in the applicable contract issued by the Plan under which the affected Member is covered. Notwithstanding anything in this Agreement to the contrary, in no event, including, but not limited to, nonpayment by the Plan, the insolvency of the Plan or breach of this Agreement, shall any Member be liable for any amount owing to the Provider by the Plan, and the Provider shall not xxxx, charge, collect a deposit or other sum, or seek compensation, remuneration or reimbursement from, or maintain any action or have any recourse against, or make any surcharge upon a Member or any person acting on a Member’s behalf. Whenever any such charge has occurred, the Provider shall refund such charge to the Member within fifteen (15) days of discovering, or receiving notification of, the charge. If the Plan receives notice of any such charge, the Plan may take appropriate action to remedy the situation, including, without limitation, offsetting any such charge against amounts due to the Provider and/or immediate termination pursuant to this Agreement. This provision shall not prohibit collection of supplemental charges or copayments made in accordance with the terms of the Plan.
Balance Billing. In-Network Providers are prohibited from balance billing. In-Network Providers have signed an agreement to accept a predetermined allowed amount for Covered Services rendered to a Member. A Member is not liable for fees in excess of the allowed amount for a Covered Service, except what is due under the Contract, e.g., Copayments, Deductibles or Coinsurance. Out-of-Network Providers are not under an agreement with Alliant and may bill You for fees in excess of the MAC. Non-Covered Services are the sole responsibility of the Member when received from any Provider regardless of network status. COORDINATION OF BENEFITS (COB) Whenever the benefits under any other plan are payable without regard to benefits payable under this plan, this plan determines its order of benefits using the first of the following rules that apply. Services that are not eligible for benefits under both plans will not be subject to coordination of benefits.
