No Medical Necessity. Neither Plan nor any Plan Provider shall bill a Member for services rendered that are determined not to be Medically Necessary or Benefits, unless (i) the services are non-emergent and the Member obtains such services without Authorization; or (ii) the Member is advised prior to the rendering of those services that the services are not covered, and the Member agrees in writing to be financially responsible for those services.
Appears in 5 contracts
Samples: Sharp Health Plan Group Agreement, Sharp Health Plan Group Agreement, Sharp Health Plan Group Agreement
No Medical Necessity. Neither Plan nor any Plan Provider shall bill xxxx a Member for services rendered that are determined not to be Medically Necessary or Benefits, unless (i) the services are non-emergent and the Member obtains such services without Authorization; or (ii) the Member is advised prior to the rendering of those services that the services are not covered, and the Member agrees in writing to be financially responsible for those services.
Appears in 3 contracts
Samples: Sharp Health Plan Group Agreement, California Health Benefit, Sharp Health Plan Group Agreement
No Medical Necessity. Neither the Plan nor any Plan Provider shall bill xxxx a Member for services rendered that are determined not to be Medically Necessary or Benefits, unless (i) the services are non-emergent and the Member obtains such services without Authorization; Authorization or (ii) the Member is advised prior to the rendering of those services that the services are not covered, and the Member agrees in writing to be financially responsible for those services.
Appears in 1 contract
Samples: Sharp Health Plan Group Agreement
