Costs of Non-covered Services. Provider must inform Covered Persons of the costs for non-covered services prior to rendering such services and must obtain a signed private pay form from such Covered Person.
Appears in 3 contracts
Samples: www.uhchearing.com, www.uhchearing.com, learn.optumrx.com
Costs of Non-covered Services. Provider must inform Covered Persons Members of the costs for non-non- covered services prior to rendering such services and must obtain a signed private pay Private Pay form from such Covered Persona Member.
Appears in 1 contract
Samples: Dental Provider Agreement
Costs of Non-covered Services. Provider must inform Covered Persons Members of the costs for non-covered services prior to rendering such services and must obtain a signed private pay form Private Pay Form (to be supplied by Provider) from such Covered PersonMember.
Appears in 1 contract
Samples: Master Dental Provider Agreement
