Practitioner Services Clause Samples

Practitioner Services. Charges for the services of the following Duly Licensed practitioners will be eligible. Unless specifically stated in the benefit booklet (as posted on the Board's intranet site), no benefits will be payable for tests, completion of reports or consultations with any person other than a Covered Person. A Physician's written authorization is only required for practitioner services where specified below. Physiotherapist or Certified Athletic Therapist (The services of a physiotherapist who has an agreement with the provincial health insurance plan will not be covered) Clinical Psychologist or Marriage and Family Therapist, up to a maximum of $500 per Covered Person in a calendar year Massage Therapist, up to a maximum of $500 per Covered Person in a calendar year Speech Pathologist, up to a maximum of $350 per Covered Person in a calendar year Chiropractor*, Osteopath, Podiatrist*, Chiropodist or Naturopath, up to a maximum of $500 per Covered Person per practitioner in a calendar year. This limit will include coverage for one x-ray taken by each practitioner each calendar year for each Covered Person.
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Practitioner Services. The Health Plan shall provide medically necessary practitioner services in accordance with the Practitioner Services Coverage and Limitations Handbook, and including the limitations and requirements specified below. a. Primary Care Services (1) The Health Plan shall process claims for and, if capitated or are approved by the Agency to subcapitate for certain covered services, pay certain physicians who provide Florida Medicaid-covered eligible primary care services in accordance with sections 1902(a)(13), 1902(jj), 1932(f), and 1905(dd) of the Social Security Act, as amended by the Affordable Care Act and 42 CFR sections 438, 441 and 447, for dates of service on or after January 1, 2013, through December 31, 2014. This provision also applies to any payments made through subcapitation arrangements. For Health Plans with subcapitation arrangements, the Agency recommends that the Health Plan implement a physician payment increase methodology similar to the Agency’s payment methodology approved by federal CMS. For purposes of sub-item 23., the term capitated Health Plan includes FFS PSNs approved to subcapitate for services. (2) The capitated Health Plan shall ensure the physician payment specified in this section applies to such primary care services provided by physicians with a specialty designation of family medicine, general internal medicine, or pediatric medicine or related subspecialists. Physicians affected include the following: (a) A physician as defined in 42 CFR 440.50; or provider under the personal supervision of a physician who self-attests to a specialty designation of family medicine, general internal medicine or pediatric medicine; or a subspecialty recognized by the American Board of Medical Specialties (ABMS), the American Board of Physician Specialties (ABPS) or the American Osteopathic Association (AOA); and (b) A physician who self-attests that he/she is board certified with such a specialty or subspecialty and/or has furnished evaluation and management services and vaccine administration services under the codes listed below that equal at least sixty percent (60%) of the Medicaid codes he or she has billed during the most recently completed calendar year or, for newly eligible physicians, the prior month. (3) The Health Plan shall ensure that increased payments specified in this provision are not provided to physicians delivering primary care services at FQHCs, RHCs or CHDs. (4) The capitated Health Plan shall make increased physician ...
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Practitioner Services. (a) The Company will coordinate the delivery of the Practitioner Services to the Client. (b) The Client agrees and acknowledges that: (i) the Company engages numerous Affiliate Centres and Practitioners to provide the Practitioner Services and the Company’s obligation with respect to the Practitioner Services is limited to the coordination of their delivery in accordance with this Agreement; (ii) the Company does not ordinarily employ Practitioners nor provide Practitioner Services; (iii) unless the Client is otherwise advised by the Company, each Practitioner is directly responsible for the Practitioner Services it provides to the Client; (iv) despite anything to the contrary in this Agreement, the Company assumes no liability for any Practitioner Services; and (v) the Client waives and releases the Company from any and all liability in relation to the Practitioner Services including (without limitation) their performance or non-performance or the nature or correctness of the Practitioner Services or their results, except to the extent of any gross negligence of Willful Misconduct on the part of the Company.
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Practitioner Services. (a) The Company has been appointed by the Practitioners to invoice and collect all Services Fees payable by the Client for the Practitioner Services, and the Client must pay any Services Fees in respect of the Practitioner Services to the Company. (b) Unless otherwise agreed in writing, the Company will charge the Client its standard rates for the provision of each Practitioner Service provided, as may be applicable at that time. (c) Any additional fees charged by Practitioners or Affiliate Clinics (including, without limitation, cancellation fees) that are not included in the Company’s Service Fees will be on-charged to and payable by the Client.
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Practitioner Services. OLPG, by and through HSC-S Faculty, shall provide the following health care professional services: (1) professional medical services to and for patients at Hospitals, including medically indigent and uninsured patients, as defined by Louisiana law (“Professional Services”); and (2) on call coverage services to the Hospitals (“On Call Coverage”). Collectively, Professional Services and On Call Coverage shall be referred to as “Practitioner Services.”
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Practitioner Services. Practitioner I description of the orthopedic shoe and modification(s) is required. Boots, sandals or sport-specific footwear are not eligible. 80% to a benefit maximum of $300 per participant per Practitioner I Services are provided to a combined benefit maximum per participant per benefit year. The services of an occupational therapist must be prescribed by a physician or nurse practitioner. Practitioner II Practitioner II Services are provided to a combined benefit maximum per participant per benefit year. The services of a massage therapist or nutritional counsellor must be prescribed by a physician or nurse practitioner.
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Practitioner Services. Charges for the services of the following Duly Licensed practitioners will be eligible. specifically stated, no benefits will be payable for tests, completion of reports or consultations with any person other than a Covered Person. A Physician’s written authorization is only required for practitioner services where specified below. Physiotherapist or Certified Athletic Therapist, up to a combined maximum of per Covered Person in a calendar year. (The services of a physiotherapist who has an agreement with provincial health insurance plan will not be covered.) Clinical Psychologist or Marriage and Family Therapist, up to a combined maximum of per Covered Person in a calendar year. Massage Therapist, up to a maximum of per Covered Person in a calendar year. (These services must be authorized in writing by the Covered Person’s attending Physician.) Speech Pathologist, up to a maximum of per Covered Person in a calendar year. Chiropractor*, Osteopath*, Podiatrist*, Chiropodist or Naturopath, up to a maximum of per Covered Person per practitioner in a calendar year. Benefits are also payable for x-rays taken by a chiropractor, osteopath or podiatrist, up to a maximum of per Covered Person per practitioner in a calendar year. for the these practitioners will be made any annual allowance under the health insuranceplan has been exhausted. Charges for: Drugs, and injected allergy sera which: are listed in Manulife Financial Formulary Three, are purchased on the prescription of a Physician or Dentist, and are dispensed by a Duly Licensed pharmacist, Physician, Dentist or Hospital. This includes extemporaneous preparations provided at least one of the ingredients is Drugs and medicines considered to be life sustaining (as determined by Manulife ’Financial) when purchased on the prescription of a physician or dentist and dispensed by a Duly Licensed pharmacist, physician, dentist or hospital. This includes extemporaneous preparations provided at least one of the ingredients is drugs, up to a of per Covered Person per calendar year. Insulin, needles, syringes and chemical testing agents for the management of Injected vitamins. Sclerotherapy drugs for varicose vein treatment. cessation aids, up to a three month supply per calendar year (204 tablets is the equivalent of a three month supply) and limited to two three month per Covered Person’s lifetime. For a Covered Person years of and older, charges for the following expenses which are no longer payable under a Governme...
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Related to Practitioner Services

  • Surgery Services This plan covers surgery services to treat a disease or injury when: • the operation is not experimental or investigational, or cosmetic in nature; • the operation is being performed at the appropriate place of service; and • the physician is licensed to perform the surgery. This plan covers reconstructive surgery and procedures when the services are performed to relieve pain, or to correct or improve bodily function that is impaired as a result of: • a birth defect; • an accidental injury; • a disease; or • a previous covered surgical procedure. Functional indications for surgical correction do not include psychological, psychiatric or emotional reasons. This plan covers the procedures listed below to treat functional impairments. • abdominal wall surgery including panniculectomy (other than an abdominoplasty); • blepharoplasty and ptosis repair; • gastric bypass or gastric banding; • nasal reconstruction and septorhinoplasty; • orthognathic surgery including mandibular and maxillary osteotomy; • reduction mammoplasty; • removal of breast implants; • removal or treatment of proliferative vascular lesions and hemangiomas; • treatment of varicose veins; or • gynecomastia.

  • Provider Services Charges for the following Services when ordered by a Physician for the treatment of an Injury or Illness.

  • REGULATORY ADMINISTRATION SERVICES BNY Mellon shall provide the following regulatory administration services for each Fund and Series:  Assist the Fund in responding to SEC examination requests by providing requested documents in the possession of BNY Mellon that are on the SEC examination request list and by making employees responsible for providing services available to regulatory authorities having jurisdiction over the performance of such services as may be required or reasonably requested by such regulatory authorities;  Assist with and/or coordinate such other filings, notices and regulatory matters and other due diligence requests or requests for proposal on such terms and conditions as BNY Mellon and the applicable Fund on behalf of itself and its Series may mutually agree upon in writing from time to time; and

  • Counseling Services Therapy is a relationship between people that works in part because of clearly defined rights and responsibilities held by each person. As a client in mental health counseling, you have certain rights and responsibilities that are important for you to understand. There are also legal limitations to those rights that you should be aware of. I, as your therapist, have corresponding responsibilities to you. These rights and responsibilities are described in the following sections. Mental Health Counseling has both benefits and risks. Risks may include experiencing uncomfortable feelings, such as sadness, guilt, anxiety, anger, frustration, loneliness and helplessness, because the process of psychotherapy often requires discussing the unpleasant aspects of your life. However, psychotherapy has been shown to have benefits for individuals who undertake it. Therapy often leads to a significant reduction in feelings of distress, increased satisfaction in interpersonal relationships, greater personal awareness and insight, increased skills for managing stress and resolutions to specific problems. But, there are no guarantees about what will happen. Psychotherapy requires a very active effort on your part. In order to be most successful, you will have to work on things we discuss in treatment outside of sessions, as a kind of homework. The first 2 sessions will involve a comprehensive evaluation of your needs. By the end of the evaluation, I will be able to offer you some initial impressions of what our work might include. At that point, we will discuss your treatment goals and create an initial treatment plan. You should evaluate this information and make your own assessment about whether you feel comfortable working with me. If you have questions about my procedures, we should discuss them whenever they arise. If your doubts persist, I will be happy to help you set up a meeting with another mental health professional for a second opinion or to make a move to another therapist that feels like a better fit.

  • Hospice Services Services are available for a Member whose Attending Physician has determined the Member's illness will result in a remaining life span of six months or less.