Member Protections. 4.5.1 Providers shall not discriminate in their treatment of Members based on Members’ health status, source of payment, cost of treatment, participation in Benefit Plans, race, ethnicity, national origin, religion, gender, age, mental or physical disability, sexual orientation, or genetic information.
4.5.2 In no event including nonpayment by Health Plan, Health Plan’s insolvency or breach of this Agreement, shall a Provider xxxx, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against any Member or persons (other than Health Plan) acting on the Member’s behalf, for amounts that are the legal obligation of Health Plan. This provision (a) shall survive termination or expiration of this Agreement regardless of the cause giving rise to termination or expiration, (b) shall be construed for the benefit of Members, (c) does not prohibit collection of Member Expenses where lawfully permitted or required, and (d) supersedes any oral or written agreement to the contrary now existing or hereafter entered into between a Provider and Members or persons acting on their behalf.
4.5.3 Regardless of any denial of a claim or reduction in payment to a Provider by Health Plan, in no event will a Member be responsible for payment for any Covered Services other than Member Expenses. However, Members shall not be responsible for Member Expenses where collection of Member Expenses is prohibited by Laws, Program Requirements, or this Agreement. If payment of an amount sought in a claim is denied or reduced by Health Plan, the Provider shall adjust Member Expenses accordingly.
4.5.4 Except where collection of Member Expenses is prohibited by Laws, Program Requirements, or this Agreement, a Provider shall (a) collect Member Expenses directly from the Member, and (b) not waive, discount or rebate any such amounts except as permitted by and in accordance with Laws and Program Requirements regarding prohibited inducements to Federal Health Care Program beneficiaries.
4.5.5 Providers shall not xxxx Members for any items or services, such as missed appointments or administrative fees, where such billing is prohibited by Laws or Program Requirements.
Member Protections. Provider agrees to observe, protect and promote the rights of Members as patients in accordance with state law and all rules and regulations promulgated by the Louisiana Department of Insurance (“LDI”) and DHH, including a Patient’s Xxxx of Rights, any and all applicable patient protection laws, and other laws promoting the well- being of patients enrolled in a Plan. La. R.S. 22:971.
Member Protections a. Contractor shall hold all Members harmless and prevent such Members from incurring financial liabilities for payment of fees that are the legal obligation of Health Plans or CompCare. In the event of failure by Health Plans or CompCare to meet any of its financial obligations, Contractor shall not xxxx, charge, collect a deposit from, or receive or demand other compensation or remuneration from a Member. This does not prohibit Contractor from collecting applicable coinsurance, deductibles, or co-payments as specified in the Member’s Evidence of Benefits or such other Health Plans documentation, as applicable. This hold harmless obligation applies, but is not limited, to the following circumstances: insolvency of Health Plans or CompCare, nonpayment by Health Plans or CompCare, breach of the Agreement by Health Plans, or CompCare’s breach of its agreement with any Contractor.
b. As applicable, Contractor shall hold all Members harmless and prevent such Members from incurring financial liabilities for payment of cost-sharing amounts, including, without limitation, deductibles and co-insurance amounts, that are the legal obligation of an applicable state Medicaid program.
c. As applicable, Contractor shall provide Services to Members who are receiving inpatient care on the date of expiration or termination or non-renewal of the Agreement through the later of (i) the date of discharge or (ii) when medically appropriate alternative care is arranged for the Member (“Continuation Services”). Such Continuation Services, including payment for such Continuation Services, shall be provided in accordance with the terms of the Agreement, unless the parties otherwise agree in writing.
Member Protections. Each of the Contractor’s Approved ACO Agreements with a Contracting MCO shall obligate the Contractor to:
A. Receipt and Timely Resolution of Attributed Members’ Grievances The Contractor shall assist the Contracting MCO to ensure the receipt and timely resolution of Attributed Members’ Grievances, including assisting the Contracting MCO to:
1. Within 30 days of the Operational Start Date, provide Attributed Members information on the Contractor’s Grievance procedures, including the right to file Grievances, the requirements and timeframes for filing and resolving a Grievance, and the availability of assistance in the filing process;
2. Notify Attributed Members of their access to the EOHHS Appeals and Ombudsman processes, and not in any way attempt to limit an Attributed Member’s access or utilization of said processes;
3. Notify Attributed Members of the receipt, orally or in writing, of a Grievance within two
Member Protections. Provider agrees;
4.1. To work with Health Net in conducting a health assessment of all new Members within ninety (90) days of the effective date of enrollment.
4.2. To provide all covered benefits to Members in a manner consistent with professionally recognized standards of health care.
4.3. To comply with all confidentiality and Member record accuracy requirements.
Member Protections. Provider agrees:
4.1. To work with Health Net in conducting a health assessment of all new Members within ninety (90) days of the effective date of enrollment.
4.2. To provide all covered benefits to Members in a manner consistent with professionally recognized standards of health care.
4.3. To comply with all confidentiality and Member record accuracy requirements.
4.4. To hold harmless and protect Members from incurring financial liabilities that are the legal obligation of Health Net or Provider. In no event, including but not limited to, nonpayment or breach of an agreement by Health Net, Provider, or any intermediary, shall Provider xxxx, charge, collect a deposit from or receive other compensation or remuneration from a Member. Provider shall not take any recourse against a Member, or a person acting on behalf of a Member, for services provided. This provision also does not prohibit (i) collection of applicable coinsurance, deductibles, or co-payments, as specified in the Evidence of Coverage, or (ii) collection of fees for non-covered services, provided the Member was informed in advance of the cost and elected to have non-covered services rendered.
4.5. To protect Members who are hospitalized from loss of benefits through the date of discharge or through the period of time HCFA premiums are paid.
Member Protections. The Contractor agrees to protect Members from certain payment liabilities and not hold Members liable for:
a. Any and all debts of the Contractor if it should become insolvent;
b. Payment for services provided by the Contractor if the Contractor has not received payment from the State for the services, or if the Provider, under contract or other arrangement with the Contractor, fails to receive payment from the State or Contractor;
c. The payments to Providers that furnish covered services under a contract or other arrangement with the Contractor that are in excess of the amount that normally would be paid by the Member if the services had been received directly from the Contractor; and
d. The Contractor agrees to honor and be bound by Section 1128B(d)(1) of the Balanced Budget Act of 1997 which protects Members against balance billing by Subcontractors.
Member Protections
