Exception for Other Coverage. Participating Providers may seek reimbursement from other third party payers for the balance of their reasonable charges for services rendered under this plan. Claims Review Blue Shield reserves the right to review all claims to determine if any exclusions or limitations apply, and may use the services of Physician consultants, peer review committees of professional societies or hospitals, and other consultants. Reductions - Third Party Liability
Exception for Other Coverage. A Participating Provider may seek reimbursement from other third-party payors for the balance of their charges for services you receive under this plan. If you recover from a third party the reasonable value of Covered Services received from a Participating Provider, the Participating Provider is not required to accept the fees paid by Blue Shield as payment in full. You may be liable to the Participating Provider for the difference, if any, between the fees paid by Blue Shield and the reasonable value recovered for those services.
Exception for Other Coverage. A Participating Dentist may seek reimbursement from other third party payors for the balance of its reasonable charges for Covered Services ren- dered under this Plan. Reductions
Exception for Other Coverage. Participating Providers may seek reimbursement from other third party payers for the balance of their reasonable charges for services rendered under this plan. exceed what Blue Shield would have paid if the Member were not eligible to receive Medicare benefits. Payment will be based on an amount that may be lower but will not exceed the Medicare allowed amount. The Blue Shield plan applicable Deductible, Copayments, and Coinsurance will be applied before plan Benefits are provided. Medi-Cal Eligible Members Medi-Cal always provides benefits last. Qualified Veterans If the Member is a qualified veteran Blue Shield will pay the reasonable value or Blue Shield’s Allowable Amount for Covered Services provided to at a Veterans Administration facility for a condition that is not related to military service. If the Member is a qualified veteran who Claims Review Blue Shield reserves the right to review all claims to determine if any exclusions or limitations apply, and may use the services of Physician consultants, peer review committees of professional societies or hospitals, and other consultants. Reductions - Third Party Liability
Exception for Other Coverage. Participating Providers and Preferred Providers may seek reimbursement from other third party payers for the balance of their reasonable charges for Services rendered under this Agreement. Claims Review Blue Shield of California reserves the right to review all claims to determine if any exclusions or limitations apply, and may use the services of Physician consultants, peer re- view committees of professional societies or hospitals, and other consultants.
Exception for Other Coverage. A Plan Dentist may seek reimbursement from other third party payers for the balance of its reasonable charges for services rendered under this Plan.
Exception for Other Coverage. A Plan Provider may seek reimbursement from other third party payers for the balance of its rea- sonable charges for Services rendered under this Plan.
Exception for Other Coverage. Participating Providers may seek reimbursement from other third party payers for the balance of their reasonable charges for services rendered under this plan. When Blue Shield provides benefits after Medicare, the combined benefits from Medicare and the Blue Shield plan will equal but not exceed what Blue Shield would have paid if the Member were not eligible to receive Medicare benefits. Payment will be based on an amount that may be lower but will not exceed the Medicare allowed amount. The Blue Shield plan applicable Deductible, Copayments, and Claims Review Blue Shield reserves the right to review all claims to determine if any exclusions or limitations apply, and may use the services of Physician consultants, peer review committees of professional societies or hospitals, and other consultants. Reductions - Third Party Liability
Exception for Other Coverage. A Plan Provider may seek reimbursement from other third party payers for the balance of its reasonable charges for Ser- vices rendered under this Plan.
Exception for Other Coverage. A Participating Dentist may seek reimbursement from other third party payors for the balance of its reasonable charges for services rendered under this Plan. REDUCTIONS — THIRD PARTY LIABILITY If a Member is injured or becomes ill due to the act or omission of another person (a “third party”), Blue Shield or a Dental Plan Administrator shall, with re- spect to services required as a result of that injury, pro- vide the Benefits of the Plan and have an equitable right to restitution, reimbursement or other available remedy to recover the amounts Blue Shield paid for services provided to the Member paid by Blue Shield or a Dental Plan Administrator on a fee-for-service basis from any recovery (defined below) obtained by or on behalf of the Member, from or on behalf of the third party re- sponsible for the injury or illness or from uninsured/un- derinsured motorist coverage. This right to restitution, reimbursement or other available remedy is against any recovery the Member receives as a result of the injury or illness, including any amount awarded to or received by way of court judgment, arbitration award, settlement or any other arrangement, from any third party or third party insurer, or from uninsured or underinsured mo- torist coverage, related to the illness or injury (the “Re- covery”), without regard to whether the Member has been “made whole” by the Recovery. The right to resti- tution, reimbursement or other available remedy is with respect to that portion of the total Recovery that is due for the Benefits paid in connection with such injury or illness, calculated in accordance with California Civil Code Section 3040. The covered Member is required to:
