Common use of Liability Calculation Method Per Claim Clause in Contracts

Liability Calculation Method Per Claim. The calculation of Subscriber liability on claims for covered health care services incurred outside the geographic area Blue Shield of California serves, and processed through BlueCard will be based on the lower of the provider's billed charges or the negotiated price Blue Shield of California pays the Host Blue. The methods employed by a Host Blue to determine a negotiated price will vary among Host Blues based on the terms of each Host Blue’s provider contracts. The negotiated price paid to a Host Blue by Blue Shield of California on a claim for health care services processed through BlueCard may represent: