Common use of Determinations as to Covered Services Clause in Contracts

Determinations as to Covered Services. HCT shall retain the right and sole responsibility to determine whether a service is a Covered Service. Provider shall not xxxx or seek payment from a Member or other persons acting on the Member’s behalf for Covered Services rendered except: (i) payment for services which are not Covered Services, provided Provider has informed the Member of the charges prior to performing the services and received from the Member a signed writing acknowledging the Member’s responsibility for payment; (ii) the amount of co-payment the Member is required to make under his/her Certificate of Coverage, which shall not exceed the Contract Rate; (iii) the applicable amount of coinsurance, which shall be calculated on the basis of the Contract Rate, which shall not exceed the Contract Rate; and (iv) the applicable amount of deductible, which shall not exceed the Contract Rate.

Determinations as to Covered Services. HCT shall retain the right and sole responsibility to determine whether a service is a Covered Service. Provider Group shall not xxxx or seek payment from a Member or other persons acting on the Member’s behalf for Covered Services rendered except: (i) payment for services which are not Covered Services, provided Provider Group has informed the Member of the charges prior to performing the services and received from the Member a signed writing acknowledging the Member’s responsibility for payment; (ii) the amount of co-payment the Member is required to make under his/her Certificate of Coverage, which shall not exceed the Contract Rate; (iii) the applicable amount of coinsurance, which shall be calculated on the basis of the Contract Rate, which shall not exceed the Contract Rate; and (iv) the applicable amount of deductible, which shall not exceed the Contract Rate.

Determinations as to Covered Services. HCT shall retain the right and sole responsibility to determine whether a service is a Covered Service. Provider Group shall not xxxx bill or seek payment from a Member or other persons acting on the Member’s behalf for Covered Services rendered except: (i) payment for services which are not Covered Services, provided Provider Group has informed the Member of the charges prior to performing the services and received from the Member a signed writing acknowledging the Member’s responsibility for payment; (ii) the amount of co-payment the Member is required to make under his/her Certificate of Coverage, which shall not exceed the Contract Rate; (iii) the applicable amount of coinsurance, which shall be calculated on the basis of the Contract Rate, which shall not exceed the Contract Rate; and (iv) the applicable amount of deductible, which shall not exceed the Contract Rate.