Common use of DISCLOSURE OF PAYMENTS FOR HEALTH CARE SERVICES Clause in Contracts

DISCLOSURE OF PAYMENTS FOR HEALTH CARE SERVICES. ‌ If a member requests information on the allowable payment that a provider has agreed to accept for us for services specified by the member, we shall, at no cost to the member, provide a good faith estimate of the amount within 10 business days of the member’s request. STEP THERAPY OVERRIDE PROCESS‌ If we require that you follow a step therapy protocol to get coverage of a specific drug, you may request to override this process if certain conditions apply. You can get more information on our step therapy protocols and requesting a step therapy override by call Member Services, or logging on to your “myHealthPartners” account at xxxxxxxxxxxxx.xxx. A member, or the prescribing health care provider if designated by a member, may appeal if they deny a step therapy override request by using the complaint procedure under section “Disputes and Complaints.” We shall respond to a step therapy override request of an appeal within five day of receipt of a complete request. In cases where exigent circumstances exist, we shall respond within 72 hours of receipt of a complete request. If we do not respond within this timeline, the override request of appeal is granted and binding on us. UNAUTHORIZED PROVIDER SERVICES‌