Provider Cost definition
Examples of Provider Cost in a sentence
Emergency Services are covered at the Participating Provider Cost Share, even if you receive treatment from a Non-Participating Provider.
Air ambulance services are covered at the Participating Provider Cost Share, even if you receive services from a Non-Participating Provider.
If the provider agrees and your request is authorized, you may continue to see the Non-Participating Provider at the Participating Provider Cost Share for: • Up to 12 months; • For a maternal mental health condition, 12 months after the condition’s diagnosis or 12 months after the end of the pregnancy, whichever is later; or • If you have a terminal illness, for the duration of the terminal illness.
In some circumstances, We may authorize In-Network Provider Cost Share amounts (Deductible, Copayment, and/or Coinsurance) to apply to a claim for a Covered Service You receive from an Out-of-Network Provider.
Contractor shall submit a separate detailed Mental Health Provider Cost Report (“Cost Report”) in the format prescribed by the California Department of Health Care Services (DHCS) and a complete Financial Statement no later than 90 days after the end of the fiscal year.
You will only be responsible for the Participating Provider Cost Share.
If We certify an In-Network Provider Cost Share amount to apply to a Covered Service received from an Out-of-Network Provider, You will only be responsible for any Copayments, Coinsurance, and/or Deductibles stated in this Agreement.
If a Participating Provider is not available, you can ask to see a Non-Participating Provider at the Participating Provider Cost Share.
If you did not require Emergency Services and did not reasonably believe an emergency existed, you will be responsible for the Participating or Non-Participating Provider Cost Share for that non-emergency Covered Service.
If the services cannot reasonably be obtained from a Participating Provider, we will approve your request and you will only be responsible for the Participating Provider Cost Share.