LIABILITY OF MEMBER FOR PAYMENT. By statute, every contract between CDN and a Participating Dentist shall provide that in the event that CDN fails to pay the Participating Dentist, the Member shall not be liable to the Participating Dentist for any sums owed by CDN. In the event that CDN does not pay non-contracting Participating Dentists, the Member may be liable to the non-contracting Participating Dentist for costs of services rendered. Members will be responsible for all supplementary charges, including copayments, deductibles and procedures not covered as Plan Benefits.
LIABILITY OF MEMBER FOR PAYMENT. All non-Emergency Services or Urgent Care services must be provided by Member's Primary Care Physician, Member's PCP’s on-call Physician, or a Participating Provider referred by Member's PCP except for certain direct access Specialist benefits as described in the EOC. If Member seeks care, other than covered direct access Specialist benefits, from a Provider other than Member's PCP without a Referral, HMO will not pay the costs. Coverage for services of a Physician or other Health Professional who is not a Participating Provider requires prior authorization before the service or supply is obtained, except for Emergency Services or Urgent Care services received outside the HMO Service Area. If HMO denies payment to a non-Participating Provider, Member will be liable to the Provider for the cost of services. HMO’s contracts with its Participating Providers specify that, except for Copayments, Members are not liable for payment for Medically Necessary Covered Benefits which have the appropriate pre- authorization, even if HMO fails to pay the Participating Provider.
LIABILITY OF MEMBER FOR PAYMENT. By statute, every contract between CDN and a participating Provider shall provide that in the event that CDN fails to pay the participating Provider, the Member shall not be liable to the Provider for any sums owed by CDN. In the event that CDN does not pay non-contracting providers, the Member may be liable to the non-contracting provider for costs of services rendered. Members will be responsible for all supplementary charges, including copayments, deductibles and procedures not covered as Plan Benefits.
