Accept Reimbursement. Group agrees to accept as payment in full for Covered Services rendered to BlueLincs HMO Members the lesser of Group's Usual Charge or BlueLincs HMO's Maximum Reimbursement Allowance set forth in Article IV and hold BlueLincs HMO Members harmless from any sums in excess of this Maximum Reimbursement Allowance. Group may collect from the BlueLincs HMO Member any amounts for Noncovered Services and the applicable copayment and deductible unless prohibited by law. Until BlueLincs HMO has determined the Maximum Reimbursement Allowance and notified Group of the amount due from the BlueLincs HMO Member, if any, under the BlueLincs HMO Member's Benefit Agreement, Group shall not bill or attempt to collect from the BlueLincs HMO Member any coinsurance amounts. The total amount collected from BlueLincs HMO, or administered accounts, and the BlueLincs HMO Member for copayment, deductible and coinsurance, but not including Noncovered Services, may not exceed the lesser of Group's Usual Charge or BlueLincs HMO's Maximum Reimbursement Allowance. Group agrees to promptly refund to the BlueLincs HMO Member any amounts which may have been collected from the BlueLincs HMO Member in excess of the BlueLincs HMO Member's responsibility as shown on BlueLincs HMO's provider claims summary.
Accept Reimbursement. Group agrees to accept as payment in full for Covered Services rendered to Blue Plan65 Select Members the lesser of Group's Usual Charge or the Medicare Part B allowable charge. Medicare Part B deductible and coinsurance amounts which would ordinarily be owed by the Blue Plan65 Select Member will be paid directly to Group by The Plan on behalf of the Blue Plan65 Select Member. Group shall not bill or attempt to collect any amounts directly from the Blue Plan65 Select Member except for those services not covered by Medicare Part B. The Plan will not reimburse, nor may Group collect from the Blue Plan65 Select Member, any amounts for Professional Services unless such services have been rendered to an identifiable individual patient and are supported by a written report. Group agrees to promptly refund to the Blue Plan65 Select Member any amounts which may have been collected from the Blue Plan65 Select Member in excess of the Blue Plan65 Select Member's responsibility as shown on The Plan's provider claims summary.
Accept Reimbursement. Group agrees to accept as payment in full for Covered Services rendered to Members the lesser of Group’s Usual Charge or The Plan’s Maximum Reimbursement Allowance set forth in Article V and hold Members harmless from any sums in excess of this Maximum Reimbursement Allowance. Group may collect from the Member any amounts for Noncovered Services and the applicable copayment and deductible unless prohibited by law. Until The Plan has determined the Maximum Reimbursement Allowance and notified Group as to the amount due from the Member, if any, under the Member’s Benefit Agreement, Group shall not bill or attempt to collect from the Member any coinsurance amounts. The total amount collected from The Plan, or administered accounts, and the Member for copayment, deductible, and coinsurance, but not including Noncovered Services, may not exceed the lesser of Group’s Usual Charge or The Plan’s Maximum Reimbursement Allowance. Group agrees to promptly refund to the Member any amounts which may have been collected from the Member in excess of the Member’s responsibility as shown on The Plan’s provider claims summary.
Accept Reimbursement. Hospital agrees to accept as payment in full the lesser of Hospital’s charges for Covered Services or The Plan’s Maximum Reimbursement Allowance set forth in Article IV of this Blue Plan65 Select Addendum. Hospital agrees to xxxx Member only for Hospital Services not covered by Medicare or the Blue Plan65 Select Benefit Agreement. Hospital shall not xxxx or attempt to collect from Member for Hospital Services denied as not Medically Necessary or Experimental/Investigational/Unproven in accordance with Article VI of the Agreement and Article V of this Blue Plan65 Select Addendum unless Hospital has obtained a Written Waiver from the Blue Plan65 Select Member prior to rendering services. Hospital shall refund to Blue Plan65 Select Member any amounts which may have been collected from the Blue Plan65 Select Member in excess of the Blue Plan65 Select Member’s responsibility as shown on The Plan’s Explanation of Claims Submission when issued.
Accept Reimbursement. Hospital agrees to accept as payment in full the lesser of Hospital’s charges for Covered Services or The Plan’s Maximum Reimbursement Allowance set forth in Article IV of this Blue Plan65 Select Addendum. Hospital agrees to xxxx Member only for Hospital Services not covered by Medicare or the Blue Plan65 Select Benefit Agreement. Hospital shall not xxxx or attempt to collect from Member for Hospital Services denied as not Medically Necessary or Experimental/Investigational/Unproven in accordance with Article VI of the Agreement and Article V of this Blue Plan65 Select Addendum unless Hospital has obtained a Written Waiver from the Blue Plan65 Select Member prior to rendering services. Hospital shall refund to Blue Plan65 Select Member any amounts which may have been collected from the Blue Plan65 Select Member in excess of the Blue Plan65 Select Member’s responsibility as shown on The Plan’s Explanation of Claims Submission when issued.
