Common use of HEALTH CARE MANAGEMENT SERVICES Clause in Contracts

HEALTH CARE MANAGEMENT SERVICES. A Member is entitled to benefits for Covered Services under this Agreement, subject to exclusions, conditions and limitations of this Agreement, and subject to Health Care Management Services administered by the Plan. When Precertification/Certification, as set forth in this Agreement, is required, Medical Necessity and Appropriateness for Covered Services will be determined prior to the Covered Service being rendered. However, when Precertification/Certification is not required, the Plan may determine that a Covered Service was not Medically Necessary and Appropriate after the Covered Service has been rendered. When a Member seeks Covered Services from an Out-of-Network Provider or outside the Network Service Area, the Member is required to call the Precertification toll-free number on the back of his/her Identification Card, prior to the receipt of the Covered Services, to determine what, if any, Precertification requirements they must follow.

HEALTH CARE MANAGEMENT SERVICES. A Member is entitled to benefits for Covered Services under this Agreement, subject to exclusions, conditions and limitations of this Agreement, and subject to Health Care Management Services administered by the Plan. When Precertification/Certification, as set forth in this Agreement, is required, Medical Necessity and Appropriateness for Covered Services will be determined prior to the Covered Service being rendered. However, when Precertification/Certification is not required, the Plan may determine that a Covered Service was not Medically Necessary and Appropriate after the Covered Service has been rendered. When a Member seeks Covered Services from an a Network Provider located Out-of-Network Provider or outside the Network Service Area, the Member is required to call the Precertification toll-free number on the back of his/her Identification Card, prior to the receipt of the Covered Services, to determine what, if any, Precertification requirements they must follow.

HEALTH CARE MANAGEMENT SERVICES. A Member is entitled to benefits for Covered Services under this Agreement, subject to exclusions, conditions and limitations of this Agreement, and subject to Health Care Management Services administered by the Plan. When Precertification/Certification, as set forth in this Agreement, is required, Medical Necessity and Appropriateness for Covered Services will be determined prior to the Covered Service being rendered. However, when Precertification/Certification is not required, the Plan may determine that a Covered Service was not Medically Necessary and Appropriate after the Covered Service has been rendered. When a Member seeks Covered Services from an Out-of-Network Provider or outside the Network Plan Service Area, the Member is required to call the Precertification toll-free number on the back of his/her Identification Card, prior to the receipt of the Covered Services, to determine what, if any, Precertification requirements they must follow.