Out-of-network provider definition

Out-of-network provider means any provider that is not directly or indirectly employed by or does not have a provider agreement with the contractor or any of its subcontractors pursuant to the contract between the department and the contractor.

Out-of-network provider means a Provider that does not have a written agreement with Us (or another Blue Cross and/or Blue Shield Plan) to provide services as a Network Provider to the Covered Person at the time services are rendered. The term “Out-of-Network Provider” includes both Plan Providers and Non- Plan Providers, but does not include Network Providers. For questions concerning Out-of-Network Providers, please call Blue Cross and Blue Shield of Illinois customer service at 1-855- 267-0214.

Out-of-network provider means a health care provider who has not contracted with a carrier to provide services to enrollees of a health benefit plan.

Examples of Out-of-network provider in a sentence

• If We approve the authorization, all services performed by the Out-of-Network Provider are subject to a treatment plan approved by Us in consultation with Your In-Network Provider, the Out-of-Network Provider and You.

• 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.

• You may be responsible for the total amount billed by an Out-of-Network Provider, even if You have been referred by another Oscar In-Network Provider, unless one of the exceptions listed above applies.

• 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.

• There are no benefits provided when using an Out-of-Network Provider and You may be responsible for the total amount billed by an Out-of-Network Provider.

More Definitions of Out-of-network provider

Out-of-network provider means a health care

Out-of-network provider means a physician, hospital, or other provider that does not have a contract with the carrier to provide services to an enrollee.

Out-of-network provider means a Non-Contracting Provider who does not have a contract with the Company to provide Covered Services by this Benefit Certificate to Covered Persons. Out-of-Network Providers are free to bill and collect from you charges for Covered Services which are in excess of the Company’s Allowance or Allowable Charge.

Out-of-network provider means any health care provider other than an in-network provider.

Out-of-network provider means a Provider who is not a member of the Delta Dental network

Out-of-network provider means any Health Care Provider with whom AvMed has neither contracted nor made arrangements to render the Covered Benefits or Covered Services described in this Contract as an In-Network Provider.

Out-of-network provider means a health care provider that