DENIED SERVICES definition

DENIED SERVICES. The procedures set forth in this Section 9.4 shall apply whenever (i) a Member appeals a denial by Medical Group of the provision of Medical Services or payment for Medical Services provided to Member on the basis of a determination that such Medical Services are not Medically Necessary or are experimental, or (ii) Medical Group appeals a denial by PacifiCare of Medical Services provided to Members or payment for such services as not Medically Necessary or as experimental.
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Examples of DENIED SERVICES in a sentence

  • COMPANY’S MAXIMUM LIABILITY FOR ANY TYPE OFDAMAGES OR LOSS SHALL BE LIMITED TO THE MEMBERSHIP FEE PAID TO COMPANY FOR THIS MEMBERSHIP, EXCEPT THAT IN THE EVENT THAT AN ARBITRATOR DETERMINES THAT COMPANY WRONGFULLY DENIED SERVICES TO MEMBER UNDER THIS AGREEMENT, THE ARBITRATOR MAY AWARD DAMAGES THAT INCLUDE THE REASONABLE COST OF THE REPLACEMENT SERVICES OBTAINED BY THE MEMBER, UP TO THE $1,000,000 LIMIT SET FORTH IN SECTION 2.2.

Related to DENIED SERVICES

  • Finished Services means complete end-to-end services offered by CenturyLink to wholesale customers or retail End User Customers. Finished Services do not include Unbundled Network Elements or combinations of Unbundled Network Elements. Finished Services include Access Services, private lines, retail services, and resold services.

  • Advanced Services refers to high speed, switched, broadband, wireline Telecommunications capability that enables users to originate and receive high-quality, voice, data, graphics or video Telecommunications using any technology.

  • Hospice services means palliative and supportive care and other services provided by an interdisciplinary team under the direction of an identifiable hospice administration to terminally ill hospice patients and their families to meet the physical, nutritional, emotional, social, spiritual, and special needs experienced during the final stages of illness, dying, and bereavement, as defined in Minnesota Statutes, § 144A.75, subd. 8, and includes the set of services as determined by the Medicare program under §1861(dd) of the Social Security Act and defined in 42 CFR § 418.3.

  • Covered Services means Medically Necessary health care items and services covered under a Benefit Plan.

  • Managed Services means the services provided by a Client to End Users using the SaaS and Client’s intellectual capital and/or additional services supplied by Client.