Non-Participating Provider definition

Non-Participating Provider means an Administrator Hospital or Professional Provider which does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to participants in the Participating Provider Option program or a facility which has not been designated by the Claim Administrator as a Participating Provider.

Non-Participating Provider means a Plan Hospital or Professional Pro­ vider which does not have a written agreement with Blue Cross and Blue Shield of Illinois or another Blue Cross and/or Blue Shield Plan to provide services to participants in a Participating Provider Option program or a fa­ cility which has not been designated by Blue Cross and Blue Shield of Illinois as a Participating Provider.

Non-Participating Provider means an Administrator Hospital or Pro­ fessional Provider which does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide ser­ vices to participants in the Participating Provider Option program or a facility which has not been designated by the Claim Administrator as a Par­ ticipating Provider.

Examples of Non-Participating Provider in a sentence

• The Contractor will also transfer this information at no cost to the member in instances where the member had received Covered Services from a participating network provider who is no longer in the provider network and became a Non-Participating Provider.

• The claim can be sub- mitted via the online portal or submitted to the following address: Vision Service Plan Attn: Claims Services P O Box 385018 Birmingham, AL 35238-5018 If the Member receives services from a VSP Non-Participating Provider, payment will be made directly to the Subscriber, and the Mem- ber is responsible for payment to the VSP Non- Participating Provider.

• When ser- vices are provided by a VSP Non-Participating Provider, the Provider may submit the claim or the Member can follow the “How to Submit a Member Reimbursement Form” found on xxx.XXX.xxx or contact VSP Customer Ser- vice at 1-800- 877-7195.

• If the grievance involves a Non-Participating Provider, the Subscriber should contact the ap- propriate Blue Shield of California Customer Service Department shown on the last page of this Evidence of Coverage and Health Service Agreement.

More Definitions of Non-Participating Provider

Non-Participating Provider means, for purposes of this Amendment only, with respect to a covered item or service, a physician or other health care provider who does not have a contractual relationship with BCBSMT for furnishing such item or service under the Contract to which this Amendment is attached.

Non-Participating Provider means a provider that does not have a contractual relationship with an MCE and is not on their panel of providers.

Non-Participating Provider means a Hospital or Professional Provider that either: (i) does not have a written agreement with Blue Cross and Blue Shield of Illinois or another Blue Cross and/or Blue Shield to provide services to participants in the benefit program, or; (ii) has not been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider in the benefit program.

Non-Participating Provider means a provider of medical care and/or services with which the Contractor has no Provider Agreement.

Non-Participating Provider means a provider of medical care and/or services with which the Contractor has no Provider Agreement, as this term is defined in this Agreement.

Non-Participating Provider. A Provider who doesn’t have a contract with Us to provide health care services to You. You will pay more to see a Non-Participating Provider. Out-of-Network Coinsurance: Your share of the costs of a Covered Service calculated as a percent of the Allowed Amount for the service that You are required to pay to a Non-Participating Provider. The amount can vary by the type of Covered Service. Out-of-Network Copayment: A fixed amount You pay directly to a Non-Participating Provider for a Covered Service when You receive the service. The amount can vary by the type of Covered Service. Out-of-Network Deductible: The amount You owe before We begin to pay for Covered Services received from Non-Participating Providers. The Out-of-Network Deductible applies before any Copayments or Coinsurance are applied. The Out-of-Network Deductible may not apply to all Covered Services. You may also have an Out-of-Network Deductible that applies to a specific Covered Service (e.g., a Prescription Drug Deductible) that You owe before We begin to pay for a particular Covered Service. Out-of-Pocket Limit: The most You pay during a Plan Year in Cost-Sharing before We begin to pay 100% of the Allowed Amount for Covered Services. This limit never includes Your Premium, Balance Billing charges or the cost of dental care services We do not Cover. The Out-of-Pocket Limit only applies to benefits that are part of the pediatric dental essential health benefit.

Non-Participating Provider means a Dentist who is not a Participating Provider.