Continuity of Care by a Terminated Provider. Members who are being treated for acute dental conditions, serious chronic dental conditions, or who are children from birth to 36 months of age, or who have received authorization from a now-terminated provider for dental surgery, or another dental procedure as part of a documented course of treatment, can request completion of care in certain situations with a provider who is leaving a contracted Dental Plan Administra- tor's Plan Provider Network. Contact Member Services to receive information regarding eligibility criteria and the poli- cy and procedure for requesting continuity of care from a terminated provider. Payment of Providers Blue Shield contracts with a contracted Dental Plan Adminis- trator to provide Services to our Members. A monthly fee is paid to a contracted Dental Plan Administrator for each Member. This payment system includes incentives to a con- tracted Dental Plan Administrator to manage all Covered Ser- vices provided to Members in an appropriate manner consistent with this Contract. If you want to know more about this payment system, contact dental Member Services at 0- 000-000-0000 or talk to your Plan Provider. A contracted Dental Plan Administrator is responsible for providing Covered Services and/or referring the Member to Plan Specialists and Providers. Your Dental Provider must obtain authorization from a contracted Dental Plan Adminis- trator before referring you to providers outside of the Dental Center.
Continuity of Care by a Terminated Provider. Members who are being treated for acute dental condi- tions, serious chronic dental conditions, or who are children from birth to 36 months of age; or who have received authorization from a now-terminated provider for dental surgery or another dental procedure as part of a documented course of treatment can request com- pletion of care in certain situations with a provider who is leaving a Dental Plan Administrator’s network of Participating Dentists. Contact Customer Service to re- ceive information regarding eligibility criteria and the policy and procedure for requesting continuity of care from a terminated provider. FINANCIAL RESPONSIBILITY FOR
Continuity of Care by a Terminated Provider. Members who are being treated for acute conditions, serious chronic conditions, pregnancies (including immediate postpartum care), or terminal illness; or who are children from birth to 36 months of age; or who have received authorization from a now-terminated provider for surgery or another procedure as part of a documented course of treatment can request completion of care with a provider who is leaving the Blue Shield of California provider network. Contact Member Services to receive information regarding eligibility criteria and the policy and procedure for requesting continuity of care from a terminated provider.
Continuity of Care by a Terminated Provider. Members who are being treated for acute dental conditions, se- rious chronic dental conditions, or who are children from birth to 36 months of age, or who have received Authorization from a now-terminated provider for dental surgery, or another den- tal procedure as part of a documented course of treatment, can request completion of care in certain situations with a provider who is leaving a contracted Dental Plan Administrator's Plan Provider Network. Contact Member Services to receive infor- mation regarding eligibility criteria and the policy and proce- dure for requesting continuity of care from a terminated provider.
Continuity of Care by a Terminated Provider. Members who are being treated for acute conditions, serious chronic conditions, high-risk pregnancies or pregnancies that have reached the second or third trimester can request continuation of covered services in certain situations with a provider who is terminated. Contact Member Services to receive information regarding eligibility criteria and the policy and procedure for requesting continuity of care from a terminated provider.
Continuity of Care by a Terminated Provider. Members who are being treated for acute conditions, serious chronic conditions, pregnancies (including immediate post- partum care), or terminal illness; or who are children from birth to 36 months of age; or who have received authorization from a now-terminated provider for surgery or another proce- dure as part of a documented course of treatment can request completion of care in certain situations with a provider who is leaving the Blue Shield provider network. Contact Member Services to receive information regarding eligibility criteria and the policy and procedure for requesting continuity of care from a terminated provider. CONTINUITY OF CARE FOR NEW MEMBERS BY NON-CONTRACTING PROVIDERS Newly covered Members who are being treated for acute conditions, serious chronic conditions, pregnancies (including immediate postpartum care), or terminal illness; or who are children from birth to 36 months of age; or who have re- ceived authorization from a provider for surgery or another procedure as part of a documented course of treatment can request completion of care in certain situations with a non- contracting provider who was providing services to the Member at the time the Member’s coverage became effective under this Plan. Contact Member Services to receive infor- mation regarding eligibility criteria and the written policy and procedure for requesting continuity of care from a non- contracting provider.
Continuity of Care by a Terminated Provider. Subscribers who are being treated for acute conditions, se- rious chronic conditions, pregnancies (including immediate postpartum care), or terminal illness; or who are children from birth to 36 months of age; or who have received au- thorization from a now-terminated provider for surgery or another procedure as part of a documented course of treat- ment can request completion of care in certain situations with a provider who is leaving the Blue Shield provider network. Contact Customer Service to receive information regarding eligibility criteria and the policy and procedure for requesting continuity of care from a terminated provid- er. FINANCIAL RESPONSIBILITY FOR CONTINUITY OF CARE SERVICES If a Subscriber is entitled to receive Services from a termi- nated provider under the preceding Continuity of Care pro- vision, the responsibility of the Subscriber to that provider for Services rendered under the Continuity of Care provi- sion shall be no greater than for the same Services rendered by a Preferred Provider in the same geographic area. SUBMITTING A CLAIM FORM Preferred Providers submit claims for payment after their Services have been received. You or your Non-Preferred Providers also submit claims for payment after Services have been received. You are paid directly by Blue Shield if Services are ren- dered by a Non-Preferred Provider, except in the case of Emergency Services. Requests for payment must be sub- mitted to Blue Shield within 1 year after the month Services were provided. Special claim forms are not necessary, but each claim submission must contain your name, home ad- dress, group contract number, Subscriber’s number, a copy of the provider’s billing showing the Services rendered, dates of treatment and the patient’s name. Blue Shield will notify you of its determination within 30 days after receipt of the claim. To submit a claim for payment, send a copy of your item- ized xxxx, along with a completed Blue Shield of California Subscriber’s Statement of Claim form to the Blue Shield of California service center listed on the last page of this book- let. Claim forms are available on Blue Shield’s Internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx or you may call Blue Shield of California Customer Service at the number provided on the back page of this booklet to ask for forms. If necessary, you may use a photocopy of the Blue Shield of California claim form. Be sure to send in a claim for all covered Services even if you have not yet m...
