Authorized Referrals Sample Clauses

Authorized Referrals. 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. In such circumstance, You or Your Physician or Provider must request Precertification and contact Us in advance of obtaining the Covered Service and obtain Our written approval to have the services provided by Out-of-Network Provider. It is Your responsibility to ensure that We have been contacted. 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. Please contact Us at 1-855-Oscar-55 for Authorized Referral information or to request authorization. Approvals of authorizations to Out-of- Network Providers will not be made for the convenience of You or another treating Provider and may not necessarily be to the specific Out-of-Network Provider You requested. The written authorization (the certification letter) will indicate the specific service that is approved and the specific provider that is approved to provide it. 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. Xxxxx can help You find an In-Network Provider specific to Your Plan by calling customer service at 1-855-Oscar-55 or visit Us at xxx.xxxxxxx.xxx. Your Oscar ID card identifies You and contains important health care coverage information. Carrying Your ID card at all times will ensure You always have access to this coverage information when You need it. Make sure You show Your ID card to Your doctor, Hospital, pharmacist, or other health care Provider so they know You are covered by Xxxxx. Out-of-Area Services and Out-of-Network Providers Outside Oscar’s Service Area Outside of Our Service area, Oscar covers only Emergency or Urgent Care services. If You need to go to an Out-of-Network out-of-area Provider for an Emergency or Urgent Care, the charges for that care are covered. Additionally, subject to Our prior approval, We may cover transplant services, or other highly specialized services through an Oscar designated Provider which is Out-of-Area. To the extent that the services of Out-of-Network or out-of-area Providers are covered, You are liab...

Authorized Referrals. When an Authorized Referral from a Physician who is a Prudent Buyer Plan Provider to a Non-Prudent Buyer Plan Provider is approved by Anthem Blue Cross before services are rendered, Anthem Blue Cross will provide whatever benefits are appropriate for Prudent Buyer Plan Providers (see DETERMINATION OF THE MAXIMUM ALLOWED AMOUNT and GENERAL DEFINITIONS for additional information).

Authorized Referrals. In some circumstances Anthem Blue Cross may authorize Prudent Buyer Plan Provider cost share amounts (Deductibles or Co-Payments) to apply to a claim for a covered service you receive from a Non-Prudent Buyer Plan Provider. In such circumstance, you or your Physician must contact Anthem Blue Cross in advance of obtaining the covered service. It is your responsibility to ensure that Anthem Blue Cross has been contacted. If Anthem Blue Cross authorizes a Prudent Buyer Plan Provider cost share amount to apply to a covered service received from a Non-Prudent Buyer Plan Provider, you also may still be liable for the difference between the Maximum Allowed Amount and the Non-Prudent Buyer Plan Provider's charge. Please call the customer service telephone number on your ID card for Authorized Referral information or to request authorization. CONDITIONS OF COVERAGE‌ The following conditions of coverage must be met before expenses incurred for services or supplies will be covered under this Plan.