Reasonable Charge Clause Samples
Reasonable Charge. The charge for a Covered Benefit which is determined by the HMO to be the prevailing charge level made for the service or supply in the geographic area where it is furnished. HMO may take into account factors such as the complexity, degree of skill needed, type or specialty of the Provider, range of services provided by a facility, and the prevailing charge in other areas in determining the Reasonable Charge for a service or supply that is unusual or is not often provided in the area or is provided by only a small number of providers in the area. • Referral. Specific directions or instructions from a Member’s PCP, in conformance with HMO’s policies and procedures, that direct a Member to a Participating Provider for Medically Necessary care. • Respite Care. Care furnished during a period of time when the Member's family or usual caretaker cannot, or will not, attend to the Member's needs. • Service Area. The geographic area established by HMO and approved by the appropriate regulatory authority.
Reasonable Charge. If we have already carried out any work in regards to the sale/marketing of the property by the time we receive notice of your cancellation, you’ll have to pay a reasonable charge for our work. * Sometimes our Auctions take place within the first 14 days. If a bid has been accepted by the time you cancel the Agreement, you must pay the Reservation Fee, even if it’s within the first 14 days. * If you cancel within the 14 days but we have introduced a willing Buyer to you and you sell to that Buyer within 6 months, you must pay the Reservation Fee. * You will have to pay the Withdrawal Fee if you cancel the Agreement after 14 days but before a bid is accepted. * If we withdraw your property from Auction because you have bid on your own property (in breach of the Agreement) you will have to pay the Withdrawal Fee.
Reasonable Charge. The charge for a Covered Benefit which is determined by the HMO’s Medical Director or Designee to be the prevailing charge level made for the service or supply in the geographic area where it is furnished. HMO may take into account factors such as the complexity, degree of skill needed, type or specialty of the Provider, range of services provided by a facility, and the prevailing charge in other areas in determining the Reasonable Charge for a service or supply that is unusual or is not often provided in the area or is provided by only a small number of providers in the area. • Referral. Specific directions or instructions from a Member’s PCP, in conformance with HMO’s policies and procedures, that direct a Member to a Participating Provider for Medically Necessary care. • Respite Care. Care furnished during a period of time when the Member's family or usual caretaker cannot, or will not, attend to the Member's needs. • Service Area. The geographic area established by HMO and approved by the appropriate regulatory authority.
Reasonable Charge. The charge for a Covered Benefit which is determined by the HMO to be the prevailing charge level made for the service or supply in the geographic area where it is furnished. HMO may take into account factors such as the complexity, degree of skill needed, type or specialty of the Provider, range of services provided by a facility, and the prevailing charge in other areas in determining the Reasonable Charge for a service or supply that is unusual or is not often provided in the area or is provided by only a small number of Providers in the area. • Referral. Specific directions or instructions from a Member’s PCP, in conformance with HMO’s policies and procedures, that direct a Member to a Participating Provider for Medically Necessary care.
Reasonable Charge. The charge for a Covered Benefit which is determined by the HMO to be the prevailing charge level made for the service or supply in the geographic area where it is furnished. HMO may take into account factors such as the complexity, degree of skill needed, type or specialty of the Provider, range of services provided by a facility, and the prevailing charge in other areas in determining the Reasonable Charge for a service or supply that is unusual or is not often provided in the area or is provided by only a small number of providers in the area. • Referral. Specific directions or instructions from a Member’s PCP, in conformance with HMO’s policies and procedures, that direct a Member to a Participating Provider for Medically Necessary care. • Respite Care. Care furnished during a period of time when the Member's family or usual caretaker cannot, or will not, attend to the Member's needs. • Self-injectable Drug(s). Prescription drugs that are intended to be self administered by injection to a specific part of the body to treat certain chronic medical conditions. An updated copy of the list of Self- injectable Drugs that are not Covered Benefits shall be available upon request by the Member or may be accessed at the HMO website, at ▇▇▇.▇▇▇▇▇.▇▇▇. The list is subject to change by HMO or an affiliate. • Service Area. The geographic area, established by HMO and approved by the appropriate regulatory authority. • Skilled Nursing. Services that require the medical training of and are provided by a licensed nursing professional and are not Custodial Care. • Skilled Nursing Facility. An institution or a distinct part of an institution that is licensed or approved under state or local law, and which is primarily engaged in providing Skilled Nursing care and related services for residents who require medical or nursing care, or rehabilitation services for the rehabilitation of injured, disabled, or sick persons. Skilled Nursing Facility does not include institutions which provide only minimal care, Custodial Care services, ambulatory or part-time care services, or institutions which primarily provide for the care and treatment of mental illness and substance abuse. The facility must qualify as a Skilled Nursing Facility under Medicare or as an institution accredited by the Joint Commission on Accreditation of Health Care Organizations, the Bureau of Hospitals of the American Osteopathic Association, the Commission on the Accreditation of Rehabilitative Facilities, o...
Reasonable Charge. The charge for a Covered Benefit which is determined by the HMO to be the prevailing charge level made for the service or supply in the geographic area where it is furnished. HMO may take into account factors such as the complexity, degree of skill needed, type or specialty of the Provider, range of services provided by a facility, and the prevailing charge in other areas in determining the Reasonable Charge for a service or supply that is unusual or is not often provided in the area or is provided by only a small number of providers in the area.