Member Billing. The contract must address the following:
Member Billing. Provider shall accept payment for Covered Services made by Company under the terms of this Agreement as payment-in-full and shall not solicit or accept any surety or guarantee of payment from DHH or any Member, which shall include the patient, parent(s), guardian, spouse or any other legally or potentially legally responsible person of the Member being served. In accordance with federal law and regulations, Provider shall not xxxx Members any amount greater than would be owed if Company provided the services directly. To the extent cost sharing is required of a Member, Provider shall not deny services because of the individual's inability to pay. Members shall not be held liable for the costs of any and all services not covered by Company or in cases where Provider failed to obtain required authorization.
Member Billing. Provider agrees that Members will not be billed or charged any amount for Covered Services. If services are not reimbursed because of Provider’s failure to comply with its obligations under this Agreement (e.g., for late submission of claims), Members may not be billed for those services. A Member may be billed for services that are not Covered Services under the Member’s Plan (including for services that are not considered “medically necessary” under a Plan) as long as the Member is informed that those services are not covered and has agreed, in advance, to pay for the services. This section will survive the termination of this Agreement.
Member Billing. Provider will not submit claims to or demand or otherwise collect reimbursement from a Member, or from other persons on behalf of the Member, for any Service included under this Agreement and permitted by the Medi-Cal Contract. Provider may bill the Member for non-covered services if Member agrees in advance and in writing with signature affirming agreement that such services are not covered by PARTNERSHIP.
Member Billing. Provider agrees that Members will not be billed or charged any amount for Covered Services, except for applicable copayments, coinsurance and deductible amounts. If services are not reimbursed because of Provider's failure to comply with its obligations under this Agreement (e.g., for late submission of claims), Members may not be billed for those services. A Member may be billed for services that are not Covered Services under the Member's Plan (including for services that are not considered “medically necessary” under a Plan) as long as the Member is informed that those services are not covered and has agreed, in advance, to pay for the services. This section will survive the termination of this Agreement.
Member Billing. Hospital agrees that Members will not be billed or charged any amount for Covered Services, except for applicable copayments, coinsurance and deductible amounts. If services are not reimbursed because of Hospital's failure to comply with its obligations under this Agreement (e.g., for late submission of claims), Members may not be billed for those services. A Member may be billed for services that are not Covered Services under the Member's Plan (including for services that are not considered “medically necessary” under a Plan) as long as the Member is informed that those services are not covered and has agreed, in advance, to pay for the services. This section will survive the termination of this Agreement.
Member Billing. Service Provider agrees that it will and will require Network Providers to comply with the following:
Member Billing. Nothing in this Agreement shall preclude Fitness Center from charging Member for Services rendered, where Member is determined to not be eligible, including retroactive determinations, for a program under this Agreement and where Fitness Center complied with Section
Member Billing. Provider shall not bill any Covered Person for Covered Services, except for specified coinsurance, copayments, and applicable deductibles. Nothing in this provision shall prohibit Provider from agreeing with a Covered Person to continue non- Covered Services at the Covered Person’s own expense, as long as Provider has notified the Covered Person in advance that Medicaid Direct may not cover or continue to cover specific services. Provider shall have the responsibility to collect from the Covered Person applicable deductibles, copayments, coinsurance, and fees for non-Covered Services. (Attachment Fa.viii, p.318) Provider Accessibility. Provider shall arrange for call coverage or other back-up to provide service in accordance with Medicaid Direct’s standards for provider accessibility. Provider will in addition: Offer hours of operation that are no less than the hours of operation offered to commercial plans; Make Covered Services available to Covered Persons twenty-four (24) hours a day, seven (7) days a week, including holidays, when medically necessary; and Have a “no-reject policy” for referrals within the capacity and parameters of Provider’s competencies. Provider agrees to accept all referrals meeting criteria for Covered Services that it provides when there is available capacity. (. Attachment F.a.ix, p.318)
Member Billing. Contractor must notify any Member ahead of time and shall not bill the member for covered services, except for agreed upon specified coinsurance, copayments, and applicable deductibles. This provision shall not prohibit Contractor and Member from agreeing to continue non-covered services at the member's own expense, as long as the Contractor has notified the Member in advance that the BH I/DD Tailored Plan may not cover or continue to cover specific services and the Member to receive the service.
