Common use of Copayments and Deductibles Clause in Contracts

Copayments and Deductibles. Provider is entitled to xxxx and has the responsibility to collect from a Member any applicable copayments or deductibles for Covered Services according to the terms of this Agreement. Provider understands and agrees that because of the variety of benefit structures offered by SelectCare, it is not always possible to determine, in advance, the deductible or copayment amounts to be paid by Members. Furthermore, Provider understands and agrees that SelectCare have no responsibility to pay any amount except as described in Section 5.1 and Provider shall xxxx and collect copayments, deductibles and any other fees that are the Member’s responsibility. For health care services not covered by this Agreement or which SelectCare determines are not Medically Necessary, and for so long as not prohibited by SelectCare, Provider may xxxx Member or other responsible party. Provider shall provide notice to SelectCare of all such charges. Provider agrees to notify Members, in advance of providing any uncovered services that the service is not covered by SelectCare and that Member will be responsible for all charges.

Appears in 2 contracts

Samples: Participation Agreement, Participation Agreement (Certified Diabetic Services Inc)

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Copayments and Deductibles. Provider is entitled to xxxx and has the responsibility to collect from a Member any applicable copayments or deductibles for Covered Services according to the terms of this Agreement. Provider understands and agrees that because of the variety of benefit structures offered by SelectCarePayers, it is not always possible to determine, in advance, the deductible or copayment amounts to be paid by Members. Furthermore, Provider understands and agrees that SelectCare HPN and Payers have no responsibility to pay any amount except as described in Section 5.1 6.1 and Provider shall xxxx and collect copayments, deductibles and any other fees that are the Member’s responsibility. For health care services not covered by this Agreement or which SelectCare determines HPN and/or Payer determine are not Medically Necessary, and for so long as not prohibited by SelectCareHPN and/or Payer, Provider may xxxx Member or other responsible party. , Provider shall provide notice to SelectCare HPN of all such charges. Provider agrees to notify Members, in advance of providing any uncovered services that the service is not covered by SelectCare the Payer Plan and that Member will be responsible for all charges.

Appears in 2 contracts

Samples: Ancillary Participation Agreement, Ancillary Participation Agreement (Certified Diabetic Services Inc)

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Copayments and Deductibles. Provider is entitled to xxxx and has the responsibility to collect from a Member any applicable copayments or deductibles for Covered Services according to the terms of this Agreement. Provider understands and agrees that because of the variety of benefit structures offered by SelectCarePlan Benefit Programs, it is not always possible to determine, in advance, the deductible or copayment amounts to be paid by Members. Furthermore, Provider understands and agrees that SelectCare PMC and Payers have no responsibility to pay any amount except as described in Section 5.1 6.1 and Provider shall xxxx and collect copayments, deductibles and any other fees that are the Member’s responsibility. For health care services not covered by this Agreement or which SelectCare determines PMC and/or Payer determine are not Medically Necessary, and for so long as not prohibited by SelectCarePMC and/or Payer, Provider may xxxx Member or other responsible party. Provider shall provide notice to SelectCare PMC of all such charges. Provider agrees to notify Members, in advance of providing any uncovered services that the service is not covered by SelectCare the Plan Benefit Program and that Member will be responsible for all charges.

Appears in 1 contract

Samples: Ancillary Participation Agreement (Certified Diabetic Services Inc)

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