Non-Participating Healthcare Providers Outside BCN’s Service Area Enrollee Liability Calculation Sample Clauses

Non-Participating Healthcare Providers Outside BCN’s Service Area Enrollee Liability Calculation. 1. In General When covered healthcare services are provided outside of BCN’s service area by non-participating healthcare providers, the amount(s) an Enrollee pays for such services will generally be based on either the Host Blue’s nonparticipating healthcare provider local payment or the pricing arrangements required by applicable state law. In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare provider bills and the payment BCN will make for the covered services as set forth in this paragraph.
Sample 1
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