Common use of Out-of-Network Services Clause in Contracts

Out-of-Network Services. The MCO must cover services covered under the contract out-of-network for the enrollee if the network is unable to provide such services and must ensure that the cost to the enrollee is no greater than it would be if the services were furnished within the network. Services must be covered as adequately and timely as if such services were provided within the network, and for as long as the MCO is unable to provide them. To the extent possible, the MCO must encourage out-of-network providers to coordinate with the MCO with respect to payment.

Out-of-Network Services. The MCO must cover services covered under the contract Contract out-of-network for the enrollee if the network is unable to provide such services and must ensure that the cost to the enrollee is no greater than it would be if the services were furnished within the network. Services must be covered as adequately and timely as if such services were provided within the network, and for as long as the MCO is unable to provide them. To the extent possible, the MCO must encourage out-of-network providers to coordinate with the MCO with respect to payment.

Out-of-Network Services. The MCO must cover services covered under the contract out-of-network for the enrollee if the network is unable to provide such services and must shall ensure that the cost to the enrollee is no greater than it would be if the services were furnished within the network. Services must be covered as adequately in an adequate and timely manner, as if such services were provided within the networkdefined by BMS, and for as long as the MCO is unable to provide them. To the extent possible, the MCO must shall encourage out-of-network providers to coordinate with the MCO with respect to payment.