Managed Care Payors Clause Samples

Managed Care Payors. If Resident is covered by a Managed Care Payor with whom Amsterdam has an agreement, Amsterdam will provide the level and type of covered services as defined in the agreement with the Managed Care Payor in exchange for the rate negotiated with the Managed Care Payor. In no event will the covered services provided to Resident pursuant to an agreement with a Managed Care Payor be less than the Basic Services listed in Section A(l) of this Agreement. Resident, Resident Representative and/or Sponsor will be responsible to pay (in accordance with the terms of this Agreement), or have Medicaid, Medicare or other third party payor pay Amsterdam for any applicable co- payments or deductibles required by the Managed Care Payor and any services furnished to Resident that are not covered by the Managed Care Payor. In the event of denial of payment by a Managed Care Payor, exhaustion of benefits and/or termination of coverage, the Resident, Resident Representative and/or Sponsor shall be responsible (in accordance with the terms and provisions of this Agreement) for payment to the Facility at the private pay rates and charges for such services and in accordance with applicable law.