Exception for Other Coverage. Participating Providers may seek reimbursement from other third party payers for the balance of their reasonable charges for services rendered under this plan. Blue Shield reserves the right to review all claims to determine if any exclusions or limitations apply, and may use the services of Physician consultants, peer review committees of professional societies or hospitals, and other consultants. Reductions - Third Party Liability
Exception for Other Coverage. A Participating Provider may seek reimbursement from other third-party payors for the balance of their charges for services you receive under this plan. If you recover from a third party the reasonable value of Covered Services received from a Participating Provider, the Participating Provider is not required to accept the fees paid by Blue Shield as payment in full. You may be liable to the Participating Provider for the difference, if any, between the fees paid by Blue Shield and the reasonable value recovered for those services.
Exception for Other Coverage. A Participating Dentist may seek reimbursement from other third party payors for the balance of its reasonable charges for Covered Services ren- dered under this Plan.
Exception for Other Coverage. Participating Providers and Preferred Providers may seek reimbursement from other third party payers for the balance of their reasonable charges for Services rendered under this Agreement. Blue Shield of California reserves the right to review all claims to determine if any exclusions or limitations apply, and may use the services of Physician consultants, peer re- view committees of professional societies or hospitals, and other consultants.
Exception for Other Coverage. Participating Providers may seek reimbursement from other third party payers for the balance of their reasonable charges for services rendered under this plan. exceed what Blue Shield would have paid if the Member were not eligible to receive Medicare benefits. Payment will be based on an amount that may be lower but will not exceed the Medicare allowed amount. The Blue Shield plan applicable Deductible, Copayments, and Coinsurance will be applied before plan Benefits are provided. Medi-Cal always provides benefits last. If the Member is a qualified veteran Blue Shield will pay the reasonable value or Blue Shield’s Allowable Amount for Covered Services provided to at a Veterans Administration facility for a condition that is not related to military service. If the Member is a qualified veteran who Blue Shield reserves the right to review all claims to determine if any exclusions or limitations apply, and may use the services of Physician consultants, peer review committees of professional societies or hospitals, and other consultants. Reductions - Third Party Liability
Exception for Other Coverage. A Plan Provider may seek reimbursement from other third party payers for the balance of its rea- sonable charges for Services rendered under this Plan.
Exception for Other Coverage. A Participating Dentist may seek reimbursement from other third party payors for the balance of its reasonable charges for services rendered under this Plan. REDUCTIONS — THIRD PARTY LIABILITY If a Member is injured or becomes ill due to the act or omission of another person (a “third party”), Blue Shield or a Dental Plan Administrator shall, with re- spect to services required as a result of that injury, pro- vide the Benefits of the Plan and have an equitable right to restitution, reimbursement or other available remedy to recover the amounts Blue Shield paid for services provided to the Member paid by Blue Shield or a Dental Plan Administrator on a fee-for-service basis from any recovery (defined below) obtained by or on behalf of the Member, from or on behalf of the third party re- sponsible for the injury or illness or from uninsured/un- derinsured motorist coverage. This right to restitution, reimbursement or other available remedy is against any recovery the Member receives as a result of the injury or illness, including any amount awarded to or received by way of court judgment, arbitration award, settlement or any other arrangement, from any third party or third party insurer, or from uninsured or underinsured mo- torist coverage, related to the illness or injury (the “Re- covery”), without regard to whether the Member has been “made whole” by the Recovery. The right to resti- tution, reimbursement or other available remedy is with respect to that portion of the total Recovery that is due for the Benefits paid in connection with such injury or illness, calculated in accordance with California Civil Code Section 3040. The covered Member is required to:
Exception for Other Coverage. A Participating Provider may seek reimbursement from other third-party payors for the balance of their charges for services you receive under this plan.
Exception for Other Coverage. A Participating Provider may seek reimbursement from other third-party payors for the balance of their charges for services you receive under this plan. If you recover from a third party the reasonable value of Covered Services received from a Participating Provider, the Participating Provider is not required to accept the fees paid by Blue Shield as payment in full. You may be liable to the Participating Provider for the difference, if any, between the fees paid by Blue Shield and the reasonable value recovered for those services. If you are injured or become ill due to the act or omission of another person (a “third party”), Blue Shield shall, with respect to services required as a result of that injury, provide the Benefits of the plan and have an equitable right to restitution, reimbursement, or other available remedy to recover the amounts Blue Shield paid for services provided to you on a fee-for-service basis from any recovery (defined below) obtained by or on your behalf, from or on behalf of the third party responsible for the injury or illness, and you must agree to the provisions below. In addition, if you are injured and no other person is responsible but you receive (or are entitled to) a recovery from another source, and if Blue Shield paid Benefits for that injury, you must agree to the following provisions. • All recoveries you or your representatives obtain (whether by lawsuit, settlement, insurance, or otherwise), no matter how described or designated, must be used to reimburse Blue Shield in full for Benefits Blue Shield paid. Blue Shield’s share of any recovery extends only to the amount of Benefits it has paid or will pay you or your representatives. For purposes of this provision, your representatives include, if applicable, your heirs, administrators, legal representatives, parents (if you are a minor), successors, or assignees. This is Blue Shield’s right of recovery. • Blue Shield’s right to restitution, reimbursement, or other available remedy is against any recovery you receive as a result of the injury or illness. This includes any amount awarded to you or received by way of court judgment, arbitration award, settlement, or any other arrangement, from any third party or third-party insurer, related to the illness or injury (the “Recovery”), whether or not you have been “made whole” by the Recovery. The amount Blue Shield seeks as restitution, reimbursement, or other available remedy will be calculated in accordance with Californ...
Exception for Other Coverage. A Plan Provider may seek reimbursement from other third party payers for the balance of its reasonable charges for Ser- vices rendered under this Plan.
