Common use of Emergency Claims Clause in Contracts

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. 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 AdministratorAd- ministrator, within one (1) 1 year af- ter after the treatment date. Please send this information to: Blue Shield of California P. O. P.O. Box 272590 Xxxxx30567 Salt Lake City, CA 95927UT 84130-2590 0567 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 Dental Plan Administrator Ad- ministrator will review the claim retrospectively. If a contracted Dental Plan Administrator determines that the services were not Emergency Emer- gency Services and would not other- wise otherwise have been authorized by a contracted Dental Plan Ad- ministratorAdministrator, 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 Admin- istrator 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 Member may appeal using the procedures outlined in the section entitled “Member Services and Grievance Process”. Blue Shield Online 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.

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 Ser- vice record (a copy of the Dentist’s bill) for payment to a contracted Dental Plan Administrator, within one (1) 1 year af- ter after 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 Dental Plan Administrator Ad- ministrator will review the claim retrospectively. If a contracted Dental Plan Administrator determines that the services were not Emergency Services and would not other- wise otherwise have been authorized au- thorized by a contracted Dental Plan Ad- ministratorAdministrator, 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 Administrator will notify the Member of its determination deter- mination within 30 days from receipt of the claim. If the Member disagrees with a contracted Dental Plan Administrator’s decisiondeci- sion, the Mem- ber Member may appeal using the procedures outlined in the section entitled “Member Services and Grievance Process”. Blue Shield Online Blue Shield’s internet site is located at xxxx://xxx.xxxxxxxxxxxx.xxx. Members using a personal computer and modem with World Wide Web access may view and download healthcare information and software.

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 after the treatment treat- ment 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 ser- vices were not Emergency Services and would not other- wise no otherwise have been authorized by a contracted Dental Plan Ad- ministratorAdministra- tor, and therefore, are not Covered Services under this AgreementAgree- ment, 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 Administrator will notify the Member of its determination within 30 days from receipt of the claim. If the Member disagrees with a contracted con- tracted Dental Plan Administrator’s decision, the Mem- ber Member may appeal using the procedures outlined in the section entitled Member Services and Grievance Process.