Member Billing. The contract must address the following:
i. That the provider shall not bill any Medicaid Managed Care Member for covered services, except for specified coinsurance, copayments, and applicable deductibles. This provision shall not prohibit a provider and Member from agreeing to continue non-covered services at the Member's own expense, as long as the provider has notified the Member in advance that the PHP may not cover or continue to cover specific services and the Member to receive the service; and
ii. Any provider's responsibility to collect applicable Member deductibles, copayments, coinsurance, and fees for noncovered services shall be specified.
Member Billing. Hospital agrees that Members will not be billed or charged any amount for Covered Services, except for applicable copayments, coinsurance and deductible amounts. If services are not reimbursed because of Hospital's failure to comply with its obligations under this Agreement (e.g., for late submission of claims), Members may not be billed for those services. A Member may be billed for services that are not Covered Services under the Member's Plan (including for services that are not considered “medically necessary” under a Plan) as long as the Member is informed that those services are not covered and has agreed, in advance, to pay for the services. This section will survive the termination of this Agreement.
Member Billing. Provider shall accept payment for Covered Services made by Company under the terms of this Agreement as payment-in-full and shall not solicit or accept any surety or guarantee of payment from DHH or any Member, which shall include the patient, parent(s), guardian, spouse or any other legally or potentially legally responsible person of the Member being served. In accordance with federal law and regulations, Provider shall not xxxx Members any amount greater than would be owed if Company provided the services directly. To the extent cost sharing is required of a Member, Provider shall not deny services because of the individual's inability to pay. Members shall not be held liable for the costs of any and all services not covered by Company or in cases where Provider failed to obtain required authorization.
Member Billing. Provider will not submit claims to or demand or otherwise collect reimbursement from a Member, or from other persons on behalf of the Member, for any Service included under this Agreement and permitted by the Medi-Cal Contract. Provider may bill the Member for non-covered services if Member agrees in advance and in writing with signature affirming agreement that such services are not covered by PARTNERSHIP.
Member Billing. Provider agrees that Members will not be billed or charged any amount for Covered Services. If services are not reimbursed because of Provider’s failure to comply with its obligations under this Agreement (e.g., for late submission of claims), Members may not be billed for those services. A Member may be billed for services that are not Covered Services under the Member’s Plan (including for services that are not considered “medically necessary” under a Plan) as long as the Member is informed that those services are not covered and has agreed, in advance, to pay for the services. This section will survive the termination of this Agreement.
Member Billing. Such obligations and the provisions of this Section will supersede any oral or written agreementto the contrary now existing or hereafter entered into between Provider and any Medi-CalMember or any persons acting on their behalf. Provider will assist PARTNERSHIP in the orderly transfer of Medi-Cal Members to the Participating Provider they choose or to whom they are referred. Furthermore, Provider shall assist PARTNERSHIP in the transfer of care as set forth in the Provider Manual, in accordance with the Phase-out Requirements set forth in the Medi-Cal Contract.
Member Billing. Contractor must notify any Member ahead of time and shall not bill the member for covered services, except for agreed upon specified coinsurance, copayments, and applicable deductibles. This provision shall not prohibit Contractor and Member from agreeing to continue non-covered services at the member's own expense, as long as the Contractor has notified the Member in advance that the BH I/DD Tailored Plan may not cover or continue to cover specific services and the Member to receive the service.
Member Billing. (i) Covered Services. Provider agrees that in no event, including but not limited to nonpayment by the Health Plan, insolvency of the Health Plan, or breach of this Agreement, shall Provider xxxx, charge, collect a deposit or gross receipts tax from, seek remuneration or reimbursement from, or have any recourse against, Member, person to whom health care services have been provided, or person acting on behalf of the Member, or HSD, for Covered Services provided pursuant to this Agreement. This does not prohibit Provider from collecting coinsurance, deductibles, or Copayment Charges as specifically provided in the Health Benefit Program, or fees for uncovered health care services delivered on a fee-for- service basis to persons referenced above, nor from any recourse against the Health Plan or its successor.
Member Billing. Nothing in this Agreement shall preclude Fitness Center from charging Member for Services rendered, where Member is determined to not be eligible, including retroactive determinations, for a program under this Agreement and where Fitness Center complied with Section
Member Billing. The contract must address the following:
