Non-Contracting Provider definition

Non-Contracting Provider means any health care provider that has not contracted with CareFirst BlueChoice to provide Covered Services to Members. Neither Participating Dentists or Non-Participating Dentists who provide Covered Dental Services nor Non-Contracting Vision Providers who provide Covered Vision Services are Non-Contracting Providers for the purposes of this definition.

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Non-Contracting Provider means any provider with an ODM provider agreement who does not contract with an MCE, but delivers health care services to an MCE's members.

Non-Contracting Provider means any health care provider that has not contracted with CareFirst BlueChoice to provide Covered Services to Members. Neither Participating Dentists or Non-Participating Dentists who provide Covered Dental Services nor Non-Contracting Vision Providers who provide Covered Vision Services are Non-Contracting Providers for the purposes of this definition. Non-Contracting Vision Provider means any optometrist or ophthalmologist licensed as such by the duly constituted authority in the jurisdiction in which Covered Vision Services are rendered when acting within the scope of such license; and, who does not have an agreement with the Vision Care Designee for the rendering of Covered Vision Services. A Non-Contracting Vision Provider may or may not have contracted with CareFirst BlueChoice. The Member should contact the Vision Care Designee for the current list of Contracting Vision Providers.

Examples of Non-Contracting Provider in a sentence

• When a Member receives Emergency Services, Urgent Care, or follow-up care after emergency surgery from a Non-Contracting Provider, the Member must follow the proof of loss requirements of the Agreement.

• If the Member has paid a Contracting Provider or Non-Contracting Provider for Covered Services rendered, benefits will be payable to the Member.

• The Member is responsible for any applicable Deductible, Copayment and Coinsurance stated in the Schedule of Benefits, and the Contracting Provider or Non-Contracting Provider may bill the Member directly for such amounts.

• If You receive services from a Non-Contracting Provider, You will be responsible for payment for services for which payment is not made by the Company due to a cost-containment policy or procedure applicable to a Contracting Provider of the same licensure providing the same service.

• When a covered service that is required for a Medical Emergency is provided by a Non-Contracting Provider, the allowable charge will be the actual charge for the service up to the maximum amount allowable for the same service provided by providers that are Contracting Institutional Providers of the Company that are the same kinds of providers or Contracting Professional Providers of the Company with the same licensure or certification.

• Coverage is provided for laboratory tests, radiologic imaging (X-rays, CAT Scans, MRIs, MRAs, etc.), and diagnostic procedures rendered by designated Contracting Providers, whether ordered by a Contracting Provider or a Non-Contracting Provider.

• Benefits may be paid to the Member or to the Non-Contracting Physician or Non-Contracting Provider at the discretion of CareFirst BlueChoice.

• Covered Services rendered at Contracting Provider radiologist offices whether ordered by a Contracting Provider or Non-Contracting Provider.

• Covered Services rendered by a Contracting Provider laboratory whether ordered by a Contracting Provider or a Non-Contracting Provider.

• Laboratory Tests and X-ray Services rendered by designated Contracting Providers, whether ordered by a Contracting Provider or a Non-Contracting Provider.

More Definitions of Non-Contracting Provider

Non-Contracting Provider means a person or entity that provides services as prescribed in A.R.S. § 36-2901, but does not have a subcontract with the Contractor.

Non-Contracting Provider means an Eligible Provider who has not entered into a Contracting Provider Agreement with the Company.