Billing of Members. Under certain programs, Members may be required to pay Copayments, Coinsurance or Deductibles for certain Covered Services. Service Provider shall collect any applicable Copayments, Coinsurance and Deductibles from Members. Copayments shall be collected at the time that Covered Services are rendered. Except for applicable Copayments, Coinsurance and Deductibles, Service Provider may bill Members only in the following circumstances. Subject to Authority's rules, policies and procedures, services that are not Covered Services may be billed to Members by Service Provider only if: (a) the Authority confirms that the services are not covered; (b) the Members were advised prior to the services being rendered that the specific services are not Covered Services; (c) the Members agreed in writing to pay for such services, and (d) such services are pre-approved by the Authority as services that may be delivered to Members. Nothing in this section is intended to prohibit or restrict Service Provider from billing individuals who were not Members at the time that services were rendered. Nothing in this section shall prohibit Practitioners and Health Care Professionals from freely communicating with Members or guardians about all treatment options, regardless of benefit coverage limitations, which may not reflect the preferences of the Authority.
Billing of Members. Provider agrees that in no event, including, but not limited to, nonpayment, insolvency, insolvency of Payor, or breach of this Agreement by Lucet, will Provider bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against a Member, or persons acting on behalf of the Member for Covered Services rendered under this Agreement. This provision does not prohibit collection of copayments, deductibles, and coinsurances made in accordance with the terms of the Member’s Plan. Subject to this Agreement, Provider is not prohibited from collecting fees for non-covered services provided to Members on a self-pay, fee-for-service basis. This Section 4.3 will survive the termination of this Agreement regardless of the cause giving rise to termination and will be liberally construed for the benefit of the Member and supersedes any oral, or written, conflicting agreement now existing between Provider and a Member or person acting on a Member’s behalf. Provider shall not enter into any oral or written agreement with a Member or person acting on a Member’s behalf that would violate or contradict this section.
Billing of Members. Under certain Plans, Members may be required to pay Copayments, Coinsurance or Deductibles for certain Covered Services. Pharmacy shall collect any applicable Copayments, Coinsurance and Deductibles from Members. Copayments shall be collected at the time that Covered Services are rendered. Except for applicable Copayments, Coinsurance and Deductibles, Pharmacy may xxxx Members only in the circumstances described below.
3.2.1 If the applicable Payor is not an HMO, Pharmacy may xxxx a Member for Covered Services provided to the Member in the event that the Payor becomes insolvent or otherwise breaches the terms and conditions of its agreement to pay, provided that (A) Pharmacy shall have first exhausted all reasonable efforts to obtain payment from the Payor, and (B) Pharmacy shall not institute or maintain any collection activities or proceed with any action at law or in equity against a Member to collect any sums that are owed by a Payor to Pharmacy unless Pharmacy provides at least thirty (30) days prior notice to Company of Pharmacy's intent to institute such an action.
3.2.2 Services that are not Covered Services may be billed to Members by Pharmacy only if (A) the Members' Plan provides and/or Company confirms that the services are not covered; (B) the Member was advised in writing prior to the services being rendered that the specific services are not Covered Services, and (c) the Member agreed in writing to pay for such services. Nothing in this section is intended to prohibit or restrict Pharmacy from billing individuals who were not Members at the time that services were rendered.
Billing of Members. Under certain Plans, members may be required to pay Copayments, Coinsurance or De- ductibles for certain Covered Services. Physician shall collect any applicable Copayments, Coinsurance and Deductibles from Members. Such amounts collected must be based only on the compensation herein. Co- payments shall be collected at the time that Covered Services are rendered. Except for applicable Copay- ments, Coinsurance and Deductibles, Physician may xxxx Members only in the circumstances described below:
3.2.1 If the applicable Payor is not an HMO, Physician may xxxx a Member for Primary Care Services provided to the Member in the event that the Payor becomes insolvent or otherwise breaches the terms and conditions of its agreement to pay, provided that: (a) Physician shall have first ex- hausted all reasonable efforts to obtain payment from the Payor; and (b) Physician shall not insti- tute or maintain any collection activities against a Member to collect any sums that are owed by a Payor to Physician unless Physician provides prior notice to Company of Physician’s intent to institute such activities.
3.2.2 Services that are not Covered Services may be billed to Members by Physician only if: (a) the Member’s Plan provides and/or Company con- firms that the services are not covered; (b) the Member was advised in writing prior to the ser- vices being rendered that the specific services may not be Covered Services; and (c) the Mem- ber agreed in writing to pay such services. Noting in this section is intended to prohibit or restrict Physician from billing individuals who were not Mem- bers at the time that services were rendered.
