Common use of Additional Expenses You Must Pay Clause in Contracts

Additional Expenses You Must Pay. In addition to your share of expenses as described above, you are responsible for payment of charges for: a. non-covered services; b. Prescription Drug Brand Additional Charges c. expenses for Claims denied because we did not receive information requested from you regarding any other coverage and the details of such coverage; and d. charges in excess of the Maximum Allowable Payment for Covered Services rendered by Non- Participating Providers who have not agreed to accept our Maximum Allowable Payment as payment in full. Except in the case of emergencies, a Member who chooses a Non-Participating Provider may be responsible to pay an amount that exceeds the Maximum Allowable Payment for the particular Health Care Services involved, in addition to the applicable Deductible and Coinsurance amounts. Also, fees that are in excess of allowable charges are not a Covered Benefit and therefore do not apply to your Deductible or annual out-of-pocket expense. In addition, if you receive services from a Non-Participating Provider you are responsible for filing the Claim, and payment will be made directly to you. If the provider files the Claim for you, payment will be made directly to the provider. WE RECOMMEND THAT, PRIOR TO CHOOSING A NON-PARTICIPATING PROVIDER FOR PARTICULAR COVERED SERVICES, YOU CONTACT MEMBER ENGAGEMENT AT THE TELEPHONE NUMBER ON THE COVER OF THIS CONTRACT OR ON YOUR AVMED IDENTIFICATION CARD TO OBTAIN AN ESTIMATE OF THE MAXIMUM ALLOWABLE PAYMENT SO THAT YOU ARE AWARE OF YOUR FINANCIAL RESPONSIBILITIES WITH REGARD TO THOSE SERVICES.

Additional Expenses You Must Pay. In addition to your share of expenses as described above, you are responsible for payment of charges for: a. non-covered services; b. Prescription Drug Brand Additional Charges; c. expenses for Claims denied because we did not receive information requested from you regarding any other coverage and the details of such coverage; and d. charges in excess of the Maximum Allowable Payment for Covered Services rendered by Non- Participating Providers who have not agreed to accept our Maximum Allowable Payment as payment in full. Except in the case of emergencies, a Member who chooses a Non-Participating Provider may be responsible to pay an amount that exceeds the Maximum Allowable Payment for the particular Health Care Services involved, in addition to the applicable Deductible and Coinsurance amounts. Also, fees that are in excess of allowable charges are not a Covered Benefit and therefore do not apply to your Deductible or annual out-of-pocket expense. In addition, if you receive services from a Non-Participating Provider you are responsible for filing the Claim, and payment will be made directly to you. If the provider files the Claim for you, payment will be made directly to the provider. WE RECOMMEND THAT, PRIOR TO CHOOSING A NON-PARTICIPATING PROVIDER FOR PARTICULAR COVERED SERVICES, YOU CONTACT MEMBER ENGAGEMENT AT THE TELEPHONE NUMBER ON THE COVER PAGE ii OF THIS CONTRACT OR ON YOUR AVMED IDENTIFICATION CARD TO OBTAIN AN ESTIMATE OF THE MAXIMUM ALLOWABLE PAYMENT SO THAT YOU ARE AWARE OF YOUR FINANCIAL RESPONSIBILITIES WITH REGARD TO THOSE SERVICES.

Additional Expenses You Must Pay. In addition to your share of expenses as described above, you are responsible for payment of charges for: a. non-covered services; b. Prescription Drug Brand Additional Charges; c. expenses for Claims denied because we did not receive information requested from you regarding any other coverage and the details of such coverage; and d. charges in excess of the Maximum Allowable Payment for Covered Services rendered by Non- Participating Out- of-Network Providers who have not agreed to accept our Maximum Allowable Payment as payment in full. Except in the case of emergencies, a Member who chooses a Nonan Out-Participating of-Network Provider may be responsible to pay an amount that exceeds the Maximum Allowable Payment for the particular Health Care Services involved, in addition to the applicable Deductible and Coinsurance amounts. Also, fees that are in excess of allowable charges are not a Covered Benefit and therefore do not apply to your Deductible or annual out-of-pocket expense. In addition, if you receive services from a Nonan Out-Participating of-Network Provider you are responsible for filing the Claim, and payment will be made directly to you. If the provider files the Claim for you, payment will be made directly to the provider. WE RECOMMEND THAT, PRIOR TO CHOOSING A NONAN OUT-PARTICIPATING OF-NETWORK PROVIDER FOR PARTICULAR COVERED SERVICES, YOU CONTACT MEMBER ENGAGEMENT AT THE TELEPHONE NUMBER ON THE COVER PAGE ii OF THIS CONTRACT OR ON YOUR AVMED IDENTIFICATION CARD TO OBTAIN AN ESTIMATE OF THE MAXIMUM ALLOWABLE PAYMENT SO THAT YOU ARE AWARE OF YOUR FINANCIAL RESPONSIBILITIES WITH REGARD TO THOSE SERVICES.

Additional Expenses You Must Pay. In addition to your share of expenses as described above, you are responsible for payment of charges for: a. non-covered services; b. Prescription Drug Brand Additional Charges; c. expenses for Claims denied because we did not receive information requested from you regarding any other coverage and the details of such coverage; and d. charges in excess of the Maximum Allowable Payment for Covered Services rendered by Non- Participating Providers who have not agreed to accept our Maximum Allowable Payment as payment in full. Except in the case of emergencies, a Member who chooses a Non-Participating Provider may be responsible to pay an amount that exceeds the Maximum Allowable Payment for the particular Health Care Services involved, in addition to the applicable Deductible and Coinsurance amounts. Also, fees that are in excess of allowable charges are not a Covered Benefit and therefore do not apply to your Deductible or annual out-of-pocket expense. In addition, if you receive services from a Non-Participating Provider you are responsible for filing the Claim, and payment will be made directly to you. If the provider files the Claim for you, payment will be made directly to the provider. WE RECOMMEND THAT, PRIOR TO CHOOSING A NON-PARTICIPATING PROVIDER FOR PARTICULAR COVERED SERVICES, YOU CONTACT MEMBER ENGAGEMENT AT THE TELEPHONE NUMBER ON THE COVER OF THIS CONTRACT OR ON YOUR AVMED IDENTIFICATION CARD TO OBTAIN AN ESTIMATE OF THE MAXIMUM ALLOWABLE PAYMENT SO THAT YOU ARE AWARE OF YOUR FINANCIAL RESPONSIBILITIES WITH REGARD TO THOSE SERVICES.

Additional Expenses You Must Pay. In addition to your share of expenses as described above, you are responsible for payment of charges for: a. non-covered services; b. Prescription Drug Brand Additional ChargesCharges (if your Plan includes prescription medication coverage); c. expenses for Claims denied because we did not receive information requested from you regarding any other coverage and the details of such coverage; and d. charges in excess of the Maximum Allowable Payment for Covered Services rendered by Non- Participating Providers who have not agreed to accept our Maximum Allowable Payment as payment in full. Except in the case of emergencies, a Member who chooses a Non-Participating Provider may be responsible to pay an amount that exceeds the Maximum Allowable Payment for the particular Health Care Services involved, in addition to the applicable Deductible and Coinsurance amounts. Also, fees that are in excess of allowable charges are not a Covered Benefit and therefore do not apply to your Deductible or annual out-of-pocket expense. In addition, if you receive services from a Non-Participating Provider you are responsible for filing the Claim, and payment will be made directly to you. If the provider files the Claim for you, payment will be made directly to the provider. WE RECOMMEND THAT, PRIOR TO CHOOSING A NON-PARTICIPATING PROVIDER FOR PARTICULAR COVERED SERVICES, YOU CONTACT MEMBER ENGAGEMENT AT THE TELEPHONE NUMBER ON THE COVER OF THIS CONTRACT OR ON YOUR AVMED IDENTIFICATION CARD TO OBTAIN AN ESTIMATE OF THE MAXIMUM ALLOWABLE PAYMENT SO THAT YOU ARE AWARE OF YOUR FINANCIAL RESPONSIBILITIES WITH REGARD TO THOSE SERVICES.