Pre-Service Claim definition

Pre-Service Claim means a claim for a medical care benefit with respect to which the plan conditions receipt of the benefit, in whole or in part, on approval of the benefit in advance of receipt of care.

Pre-Service Claim means any Claim for Benefits under a Health Benefit Plan with respect to which the terms of the Plan condition receipt of the benefit, in whole or in part, on approval of the benefit in advance of obtaining medical care.

Pre-Service Claim means any Claim for Benefits under a Group Health Plan with respect to which the terms of the Plan condition receipt of the benefit, in whole or in part, on approval of the benefit in advance of obtaining medical care.

Examples of Pre-Service Claim in a sentence

• An appeal of an Adverse Benefit Determination with respect to a Post-Service Claim may be submitted to AvMed’s Member Engagement Center, at the address listed in Appeal of a Pre-Service Claim, above.

• AvMed will notify the Claimant of the benefit determination with respect to a Pre-Service Claim no later than 15 days after receipt of the Claim.

• A Claimant may appeal an Adverse Benefit Determination with respect to a Pre-Service Claim within 365 days of receiving the Adverse Benefit Determination.

• An appeal of an Adverse Benefit Determination with respect to an Urgent Care Claim may be submitted to AvMed’s Member Engagement Center at the address listed under Appeal of a Pre-Service Claim, above.

• The Member can ask (either orally or in writing) for an Expedited Appeal of an Adverse Benefit Determination for a Pre-Service Claim that involves an Urgent Care Claim if the Member or his Physician believe that the health of the Member could be seriously harmed by waiting for a routine appeal decision.

More Definitions of Pre-Service Claim

Pre-Service Claim means any Claim for a benefit under this Plan where the Plan conditions receipt of the benefit, in whole or in part, on approval in advance of obtaining Medical Care. These are, for example, Claims subject to Preauthorization.

Pre-Service Claim means the request for a plan benefit(s) by a claimant prior to a

Pre-Service Claim means a claim for a benefit under a group health plan that, under the terms of the applicable plan, conditions the receipt of the benefit, in whole or in part, on pre-approval of the benefit in advance of obtaining medical care.

Pre-Service Claim means any claim in which receipt of the benefit is conditioned, in whole or in part, upon precertification or preauthorization by the Plan.

Pre-Service Claim means any claim for a medical benefit the health plan conditions receipt of such benefit, in whole or in part, on approval of the benefit prior to obtaining medical care.

Pre-Service Claim means any Claim or authorization or determination of Benefits under a LIBERTY Dental Plan in advance of obtaining the requested services.

Pre-Service Claim means any Claim for benefits under this Contract for which, in whole or in part, a Claimant must obtain authorization from AvMed in advance of such services being provided to or received by the Member.