Beneficiary Obligations. The beneficiary, or his or her legal representative, accepts full responsibility for payment of the physician's charge for all services furnished by the physician.
Beneficiary Obligations. The Beneficiary, or his or her legal representative, accepts full responsibility for payment of the charges for all services furnished by the Physician. The Beneficiary, or his or her legal representative, understands that no payment will be provided by Medicare for items or services furnished by the Physician that would have otherwise been covered by Medicare if there was no private contract and a proper Medicare claim had been submitted. The Beneficiary, or his or her legal representative, understands that Medicare limits or any other Medicare reimbursement regulations do not apply to what may be charged for items or services furnished by the Physician. The Beneficiary, or his or her legal representative, agrees not to submit a claim, nor ask the Physician to submit a claim, to Medicare for Medicare items or services, even if such items or services are otherwise covered by Medicare. The Beneficiary, or his or her legal representative, acknowledges that this written private contract contains sufficiently large print to ensure that the Beneficiary, or his or her legal representative, is able to read this contract. The Beneficiary, or his or her legal representative, has entered into this contract with the knowledge that he or she has the right to obtain Medicare-covered items and services from physicians and practitioners who have not opted-out of Medicare and for whom payment would be made by Medicare for their covered services, and that the Beneficiary has not been compelled to enter into private contracts that apply to other Medicare-covered services furnished by other physicians or practitioners who have not opted-out. The Beneficiary, or his or her legal representative, understands that Medigap plans do not, and other supplemental plans may elect not to, make payments for items and services not paid for by Medicare. The Beneficiary, or his or her legal representative, understands that this agreement shall not be entered into with the Physician during a time when the Beneficiary requires emergency care services or urgent care services, except that the Physician may furnish emergency or urgent care services to a Medicare beneficiary in accordance with 42 C.F.R. § 405.440. The Beneficiary, or his or her legal representative, acknowledges that a copy of this contract has been provided to the Beneficiary, or to his or her legal representative, before items or services have been furnished to the Beneficiary under the terms of this contract. The Beneficiary,...
Beneficiary Obligations. The beneficiary, or his or her legal representative, accepts full responsibility for payment of the physician’s charge for all services furnished by the physician.
Beneficiary Obligations. 2.1 In order to benefit from the MEMBERSHIP SERVICES, including but not limited to the Internet exchanges SERVICES and as described in the CONTRACT, the BENEFICIARY needs to be a member of LU-CIX and the BENEFICIARY must have paid the related membership fees to LU-CIX.
2.2 The BENEFICIARY commits to follow the rules applicable to the provision of technical SERVICES, as referred to in Clause 1.4 above. In case the BENEFICIARY does not follow these rules, LU-CIX has the right to immediately suspend the technical SERVICES as set out under Clause 4.3 and following the conditions thereof.
Beneficiary Obligations. 4.1 The beneficiary commits: to use the amount offered by the Sponsor only for the purpose provided at art. 1 and according to KIT ...., to enter it in its accounting records. The Sponsor has the right to verify if the Beneficiary complies with this obligation and may request reimbursement of the amount in the case this is used by Beneficiary for other purpose; to use the Sponsor's brand and name only in relation to the object of this contract and in accordance with its provisions; to not do any action that may affect the Sponsor's name, image, brand or reputation; to properly fulfill the obligations assumed and those obligations incumbent from the performance of this contract.
Beneficiary Obligations. 5.1 The Beneficiary undertakes and agrees at all times for the duration of these Payment Module Terms:
(a) the Beneficiary shall act in good faith at all times in its relations with Fuuse;
(b) provided that Fuuse performs its obligations in accordance with these Payment Module Terms, the Beneficiary shall indemnify Fuuse against any liabilities which Fuuse may incur provided Fuuse was acting with reasonable care and skill within the scope of its authority under these Payment Module Terms as agent for the Beneficiary;
(c) the Beneficiary shall supply Fuuse at its expense any documentation and information (in any format) and any technical, market and other support that Fuuse may from time to time reasonably require for the purpose of enabling Fuuse to properly and efficiently discharge its duties under these Payment Module Terms;
(d) the Beneficiary shall ensure the performance of any contracts for the supply of the Charging Services made on its behalf by Fuuse under these Payment Module Terms, subject to its rights under those contracts;
(e) the Beneficiary shall deal promptly and efficiently with any complaint, dispute or post-supply enquiry relating to the Charging Services raised by an End User; and
(f) the Beneficiary shall inform Xxxxx immediately in the event it is unable to perform its obligations under the Charging Services Terms or if it is unable to provide the Charging Services (including, without limitation, in the event of any issue with any Charge Point).
Beneficiary Obligations. The Beneficiary (or their legal representative) accepts full responsibility for payment to Redrose Medical for services rendered.
Beneficiary Obligations. The beneficiary or his or legal representative, accepts full responsibility for payment of the physician’s charges for all services furnished by the physician. The beneficiary, or his or her legal representative, understands that no payments will be provided by Medicare for items or services furnished by the physician that would have otherwise been covered by Medicare if there was no private contract and a proper Medicare claim had been submitted. The beneficiary, or his or her legal representatives, understands that Medicare limits do not apply to what the physician may charge for items or services furnished by the physician. The beneficiary, or his or her legal representative agrees not to submit a claim nor ask the physician to submit a claim, to Medicare for Medicare items or services, even if such items or services are otherwise covered by Medicare. The beneficiary acknowledges that this written private contract contains sufficiently large print to ensure that the beneficiary is able to read this contract. Acknowledge that Medicare plans do not, and that other supplemental insurance plans “such as FEP” may elect not to make payment for items and services furnished by the physician or practitioner under the opt out contract. Xx. Xxxxxxx X. Porter Patient Date Xx. Xxx X. Doles Witness Date Date of Birth: - - Medical Record #: Phone: ( ) Address: City: State: Zip: Date of Service: □ I authorize Dr. Xxxxxxx Xxxxxx and Xx. Xxx Xxxxx to use, disclose and retrieve my protected health information for his/her own purposes of treatment, payment, and health care operations.
Beneficiary Obligations. The beneficiary, or beneficiary’s legal representative, agrees not to submit a claim (or to request that the physician submit a claim) to the Medicare program for services rendered by the physician even if such services are otherwise covered by the Medicare program.
Beneficiary Obligations. The beneficiary, or his or her legal representative, accepts full responsibility for payment of the provider’s charge for all services furnished by the provider.
