Common use of Enrolled Member Liability Calculation Clause in Contracts

Enrolled Member Liability Calculation. When covered healthcare services are provided outside of BCBSRI service area by nonparticipating providers, the amount an Enrolled Member pays for such services will generally be based on either the Host Blue’s nonparticipating provider local payment or the pricing arrangements required by applicable law. In these situations, the Enrolled Member may be responsible for the difference between the amount that the nonparticipating provider bills and the payment BCBSRI will make for the covered services as set forth in this paragraph. Payments for out-of-network emergency services are governed by applicable federal and state law.

Enrolled Member Liability Calculation. When covered healthcare services are provided outside of BCBSRI service area by nonparticipating non-participating healthcare providers, the amount amounts an Enrolled Member pays for such services will generally be based on either the Host Blue’s nonparticipating non-participating healthcare provider local payment or the pricing arrangements required by applicable state law. In these situations, the Enrolled Member may be responsible for the difference between the amount that the nonparticipating non-participating healthcare provider bills and the payment BCBSRI will make for the covered services as set forth in this paragraph. Payments for out-of-network emergency services are governed by applicable federal and state law.