Emergency Claims Sample Clauses

Emergency Claims. If Emergency Services outside of the Service Area were re- ceived and expenses were incurred by the Member, the Mem- ber must submit a complete claim with the Emergency Service record (a copy of the Dentist’s bill) for payment to a contracted Dental Plan Administrator, within one (1) year af- ter the treatment date. Please send this information to: Blue Shield of California P. O. Box 272590 Xxxxx, CA 95927-2590 If the claim is not submitted within this period, the Plan will not pay for those Emergency Services, unless the claim was submitted as soon as reasonably possible as determined by the Plan. If the services are not pre-authorized, a contracted Den- tal Plan Administrator will review the claim retrospectively. If a contracted Dental Plan Administrator determines that the services were not Emergency Services and would not other- wise have been authorized by a contracted Dental Plan Ad- ministrator, and therefore, are not Covered Services under this Agreement, it will notify the Member of that determination. The Member is responsible for the payment of such Dental Care Services received. A contracted Dental Plan Adminis- trator will notify the Member of its determination within 30 days from receipt of the claim. If the Member disagrees with a contracted Dental Plan Administrator’s decision, the Mem- ber may appeal using the procedures outlined in the section entitled Member Services and Grievance Process.

Emergency Claims. In the event of an emergency, in order for Select to make a determination if the system and/or appliance causing the emergency is covered under this Agreement, You must contact Select prior to having the repair ment work performed. In the event the emergency pertains to gas, fire or has the potential to cause injury to You or anyone else present in or near your home, you should take all reasonable steps, including, but not limited to, vacating the premises and contacting the proper authority to ensure the safety of You and those present. Once the determination is made by the proper authority that your home is safe to re-inhabit, You must contact Select immediately and advise them of this claim.

Emergency Claims. In the event of an emergency, in order for Select to make a determination if the system and/or appliance causing the emergency is covered under this Agreement, You must contact Select prior to

Emergency Claims. If Emergency Services outside of the Service Area were re- ceived and expenses were incurred by the Member, the Mem- ber must submit a complete claim with the Emergency Service record (a copy of the Dentist’s bill) for payment to a Plan Ad- ministrator, within 1 year after the treatment date. Please send this information to: P.O. Box 30567 If the claim is not submitted within this period, the Plan will not pay for those Emergency Services, unless the claim was submitted as soon as reasonably possible as determined by the Plan. If the services are not pre-authorized, a Dental Plan Ad- ministrator will review the claim retrospectively. If a Dental Plan Administrator determines that the services were not Emer- gency Services and would not otherwise have been authorized by a Dental Plan Administrator, and therefore, are not Covered Services under this Agreement, it will notify the Member of that determination. The Member is responsible for the payment of such Dental Care Services received. A Dental Plan Admin- istrator will notify the Member of its determination within 30 days from receipt of the claim. If the Member disagrees with a Dental Plan Administrator’s decision, the Member may appeal using the procedures outlined in the section entitled “Member Services and Grievance Process”. Blue Shield’s internet site is located at xxxx://xxx.xxxxxxxxxxxx.xxx. Members using a personal com- puter and modem with World Wide Web access may view and download healthcare information and software.