Common use of Circumstances in Which an Enrollee Clause in Contracts

Circumstances in Which an Enrollee. May Be Billed (A) A Provider may bill an Enrollee for non-Covered Services only as outlined in this Contract. (B) A non-Covered Service is a service that is not covered under this Contract, or is not authorized by the Contractor.

Circumstances in Which an Enrollee. May Be Billed (A) A Provider may bill an Enrollee for non-Covered Services only as outlined in this Contract. (B) A non-Covered Service is a service that is not covered under this Contract, or includes special features or characteristics that are desired by the Enrollee (e.g., more expensive eyeglass frames, hearing aids, custom wheelchairs, etc.) but does not meet the Medical Necessity criteria for amount duration, and scope as set forth in the State Plan or is not authorized by the Contractor.