Common use of Conditions for Reimbursement for Non-Covered Services Clause in Contracts

Conditions for Reimbursement for Non-Covered Services. Neither a Member nor FHFS, nor any Payor shall be liable to pay PPG for any Contracted Services rendered by PPG to a Member which is determined under a Utilization/Care Management Program not to be Medically Necessary. Provided, however, PPG may xxxx a Member for non-Covered Services rendered by PPG to such Member only if the Member is notified in advance that the services to be provided are not Covered Services under the Member’s Benefit Program and the Member requests in writing that PPG render the non-Covered Services prior to the rendition of such services.

Conditions for Reimbursement for Non-Covered Services. Neither a Member nor FHFS, nor any Payor shall be liable to pay PPG for any Contracted Services rendered by PPG to a Member which is determined under a Utilization/Care Management Program not to be Medically Necessary. Provided, however, PPG may xxxx bill a Member for non-Covered Services rendered by PPG to such Member only if the Member is notified in advance that the services to be provided are not Covered Services under the Member’s Benefit Program and the Member requests in writing that PPG render the non-Covered Services prior to the rendition of such services.

Conditions for Reimbursement for Non-Covered Services. Neither a Member nor FHFS, nor any Payor shall be liable to pay PPG for any Contracted Services rendered by PPG to a Member which is determined under order a Utilization/Care Management Program not to be Medically Necessary. Provided, however, PPG may xxxx bill a Member for non-Covered Services rendered by PPG to such Member only if the Member is notified in advance that the services to be provided are not Covered Services under the Member’s Benefit Program and the Member requests in writing that PPG render the non-Covered Services prior to the rendition of such services.

Conditions for Reimbursement for Non-Covered Services. Neither a Member nor FHFS, nor any Payor shall be liable to pay PPG for any Contracted Services rendered by PPG to a Member which is determined under a Utilization/Care Management Program not to be Medically Necessary. , Provided, however, PPG may xxxx a Member for non-Covered Services rendered by PPG to such Member only if the Member is notified in advance that the services to be provided are not Covered Services under the Member’s Benefit Program and the Member requests in writing that PPG render the non-Covered Services prior to the rendition of such services.