How Providers Affect Your Costs Sample Clauses

How Providers Affect Your Costs for more information. You also have access to facilities, emergency rooms, surgical centers, equipment vendors or pharmacies providing covered services throughout the United States and wherever you may travel.
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How Providers Affect Your Costs. In-Network Providers This dental plan utilizes the Dental Value network providers. This plan provides you benefits for covered services from providers of your choice. You have access to one of the many providers included in our Dental Value network. This plan makes available to you a sufficient number and types of providers to give you access to all covered services in compliance with applicable Washington state regulations governing access to providers. Our provider network includes dentists and a variety of other types of providers. A list of in-network providers is available in our Dental Value provider directory. These providers are listed by member system, geographical area, specialty and in alphabetical order to help you select a provider that is right for you. We update this directory regularly, but it is subject to change. We suggest that you call us for current information and to verify that your provider, their office location, or provider group is included in the Dental Value network before you receive services. The Dental Value provider network directories are available any time on our website at xxxxxxxx.xxx. You may also request a copy of this directory by calling customer service at the number located in Contact Information or on your LifeWise ID card. As a LifeWise member, you have access to a nationwide network of Dental Value providers who can provide preventive and specialty dental care services. When you receive services from Dental Value providers, your claims will be submitted directly to us and available benefits will be paid directly to the dental care provider. Dental Value providers agree to accept our "allowed amount" as payment in full. See the Definitions section in this booklet. You're responsible only for the calendar year deductible, coinsurance, amounts that are in excess of stated benefit maximums, and charges for non-covered services.
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How Providers Affect Your Costs. No charge first 2 visits per calendar year, then $10 copay, deductible waived Deductible, then 50% coinsurance  Telehealth services. See Telehealth Virtual Care Services. $10 copay, deductible waived Deductible, then 50% coinsurance  Office visit for women’s health. For example gynecologist. $10 copay, deductible waived Deductible, then 50% coinsurance  All other office and clinic visits (including non-preventive nutritional therapy) $30 copay, deductible waived Deductible, then 50% coinsurance Home Based Chronic Care Evaluation and management services of No charge Not covered YOUR COSTS OF THE ALLOWED AMOUNT IN-NETWORK PROVIDERS OUT-OF-NETWORK PROVIDERS multiple chronic conditions provided by a doctor or nurse practitioner in your place of residence. Some services, such as x-rays, lab, and durable medical supplies charges may have additional cost to you. See those covered services for details. Preventive Care  Exams, screenings and immunizations (including seasonal immunizations in a provider’s office) are limited in how often you can get them based on your age and gender  Seasonal and travel immunizations (pharmacy, mass immunizer, travel clinic and county health department)  Health education, preventive nutritional therapy for diseases such as diabetes, and nicotine dependency treatment No charge No charge No charge Not covered No charge Not covered Contraception Management and Sterilization No charge Deductible, then 50% coinsurance Diagnostic Lab, X-ray and Imaging  Preventive care screening and tests No charge Deductible, then 50% coinsurance  Basic diagnostic lab, x-ray and imaging 20% coinsurance, deductible waived Deductible, then 50% coinsurance  Major diagnostic x-ray and imaging Deductible, then 20% coinsurance Deductible, then 50% coinsurance Pediatric Care Limited to members under age 19 Pediatric Vision Services  Routine exams limited to once per year $30 copay, deductible waived $30 copay, deductible waived  One pair glasses, frames and lenses limited to once per year. Lens features limited to polycarbonate lenses and scratch resistant coating. No charge No charge  One pair of contacts or a 12-month supply of contacts per calendar year, instead of glasses (lenses and frames) No charge No charge  Contact lenses and glasses required for medical reasons No charge No charge  One comprehensive low vision evaluation and four follow up visits in a five calendar year period No charge No charge  Low vision devices, high powered specta...
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How Providers Affect Your Costs. MEDICAL SERVICES This plan is a Preferred Provider plan (PPO). This means that your plan provides you benefits for covered services from providers of your choice. It also gives you access to the Heritage Signature provider network and to networks in other states with which we have arranged to provide covered services to you. Hospitals, physicians and other providers in these networks are called "in-network providers." A list of in-network providers is available in our LifeWise Connect provider directory. These providers are listed by geographical area, specialty and in alphabetical order to help you select a provider that is right for you. The provider directory also shows which providers you can select as your PCP. You can receive the lower copayment amount on primary care office visit copays by selecting a provider as your Primary Care Provider (PCP) and telling us the name of the PCP any time prior to an office visit. If you are having difficulty choosing an available PCP, contact us and we will assign a PCP to you. See Primary Care Office Visits for more information. We update this directory regularly, but it is subject to change. We suggest that you call us for current information and to verify that your provider and their office location or provider group are included in the LifeWise Connect network before you receive services. Our provider directory is available any time on our website at xxxxxxxxxx.xxx. You may also request a copy of this directory by calling Customer Service at the number located on the back cover or on your LifeWise ID card. In-Network Providers In-network providers provide medical services for a negotiated fee. This fee is the allowed amount for in-network providers. When you receive covered services from an in-network provider, your medical bills will be reimbursed at a higher percentage (the in-network provider benefit level). In-network providers will not charge more than the allowed amount. This means that your portion of the charges for covered services will be lower. If a covered service is not available from an in-network provider, you can receive benefits for services provided by an out-of-network provider at the in-network benefit level. See Prior Authorization for details. Out-of-Network Providers Out-of-network providers are providers that are not part of your network. Your bills will be reimbursed at the lower percentage (the out-of-network benefit level) and the provider may bill you for charges above the allowed am...
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Related to How Providers Affect Your Costs

  • Your Guide to Selecting a Primary Care Provider (PCP) and Other Providers Quality healthcare begins with a partnership between you and your primary care provider (PCP). When you need care, call your PCP, who will help coordinate your care. Your healthcare coverage under this plan is provided or arranged through our network of PCPs, specialists, and other providers. You’re encouraged to: • become involved in your healthcare by asking providers about all treatment plans available and their costs; • take advantage of the preventive health services offered under this plan to help you stay healthy and find problems before they become serious. Each member is required to provide the name of his or her PCP. However, if the name of a PCP is not provided with the application, your enrollment will not be delayed and your coverage will not be cancelled. How to Find a PCP or Other Providers Finding a PCP in our network is easy. To select a provider, or to check that a provider is in our network, please use the “Find a Doctor” tool on our website or call Customer Service. Please note: We are not obligated to provide you with a provider. We are not liable for anything your provider does or does not do. We are not a healthcare provider and do not practice medicine, dentistry, furnish health care, or make medical judgments.

  • OBLIGATIONS AND ACTIVITIES OF CONTRACTOR AS BUSINESS ASSOCIATE 1. Contractor agrees not to use or further disclose PHI County discloses to Contractor other than as permitted or required by this Business Associate Contract or as required by law.

  • Reliance on Third Party Service Providers Each Party may allow Reporting Financial Institutions to use third party service providers to fulfill the obligations imposed on such Reporting Financial Institutions by a Party, as contemplated in this Agreement, but these obligations shall remain the responsibility of the Reporting Financial Institutions.

  • Cooperation and Coordination The Parties acknowledge and agree that it is their mutual objective and intent to minimize, to the extent feasible and legal, taxes payable with respect to their collaborative efforts under this Agreement and that they shall use all commercially reasonable efforts to cooperate and coordinate with each other to achieve such objective.

  • Your Rights and Our Responsibilities After We Receive Your Written Notice We must acknowledge your letter within 30 days, unless we have corrected the error by then. Within 90 days, we must either correct the error or explain why we believe the bill was correct. After we receive your letter, we cannot try to collect any amount you question, or report you as delinquent. We can continue to bill you for the amount you question, including finance charges and we can apply any unpaid amount against your credit limit. You do not have to pay any questioned amount while we are investigating, but you are still obligated to pay the parts of your bill that are not in question. If we find that we made a mistake on your bill, you will not have to pay any finance charges related to any questioned amount. If we didn’t make a mistake, you may have to pay finance charges, and you will have to make up any missed payments on the questioned amount. In either case, we will send you a statement of the amount you owe and the date that it is due. If you fail to pay the amount that we think you owe, we may report you as delinquent. However, if our explanation does not satisfy you and you write to us within ten days telling us that you still refuse to pay, we must tell anyone we report you to that you have a question about your bill. In addition, we must tell you the name of anyone we reported you to. Upon settlement of a disputed bill, we must notify anyone we reported you to that the matter has been settled. If we don’t follow these rules, we can’t collect the first $50 of the questioned amount, even if your bill was correct.

  • Replacement of Key Personnel The Engineer must notify the State in writing as soon as possible, but no later than three business days after a project manager or other key personnel is removed from association with this contract, giving the reason for removal.

  • Cooperation of Parties The Parties to this Agreement agree to cooperate in good faith to prepare and execute all documents, to seek Court approval, defend Court approval, and to do all things reasonably necessary to complete and effectuate the Settlement described in this Agreement.

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