Common use of Network Emergency and Urgent Care Claims Clause in Contracts

Network Emergency and Urgent Care Claims. After You get Covered Services for Out-of-Network Emergency or Urgent Care, We must receive written notice of your claim within one-hundred eighty (180) days, or as soon thereafter as reasonably possible. Either the Subscriber or Provider of service must claim benefits by sending Us properly completed claim forms itemizing the services or supplies received and the charges. These claim forms must be received by Us within one- hundred eighty (180) calendar days from the date the services or supplies are received. We will not be liable for benefits if We do not receive completed claim forms within this time period. General Claim Filing Guidelines Claim forms must be used; canceled checks or receipts are not acceptable. Claim forms are available by accessing Our web site at xxx.xxxxxxx.xxx by calling the telephone number on the back of Your Identification Card or by writing to Us at the address in the next sentence. Prior to submitting Your member claim form and itemized bill, You should make copies of the documents for Your own records and attach the original bills to the completed member claim form. The bills and the member claim form should be mailed to: Oscar Health Plan of California Attn: Claims 0000 Xxxxxx Xxxx Blvd. PO Box 1279 Culver City, CA 90232 Out-of-Network providers must submit claims within one hundred eighty (180) calendar days following the dates of service unless otherwise mandated by law. A claim received after the one hundred eighty (180) days billing time limit is subject to denial. When You receive health care outside of the United States, You will need to submit an itemized bill and medical records for services rendered. The itemized bill and medical records must be translated into English and include the billed charges. Note: You are responsible, at Your own expense, for obtaining an English language translation of foreign country Provider claims and medical records. Other Charges Copayments and Coinsurance are outlined in the SUMMARY OF BENEFITS. Your Copayment and Coinsurance may be a fixed dollar amount per day, per visit, and/or it may be a percentage of the Negotiated Fee Rate. Important: You are responsible for confirming that the Provider You are seeing or have been referred to see is an In-Network Provider under Your Plan. Unless an exception (listed in the HOW YOUR COVERAGE WORKS section) applies, any claims incurred with a Provider who is not a part of Your Plan’s In-Network Providers, will not be covered. Xxxxx can help You find an In-Network Provider specific to Your Plan by calling customer service at 1-855-Oscar-55 or visit Us at xxx.xxxxxxx.xxx. These amounts are Your financial responsibility. After Your Deductible is satisfied, Copayments are normally paid by You at the time services are performed. If Your Plan contains a Deductible, You must satisfy the In-Network medical Deductible before We will make payment for services You receive, except for certain services as stated in the sections below. Additionally, the medical Deductible is explained in the SUMMARY OF BENEFITS. While Your Coinsurance financial responsibility may also be collected by the Provider at the time services are performed, the Provider may choose to bill You for these services after they have submitted the claim to Us. Cost sharing for services with Copayments is the lesser of the Copayment amount or Negotiated Fee Rate. Described below are Your Coinsurance and Out of Pocket Maximums.

Network Emergency and Urgent Care Claims. After You get Covered Services for Out-of-Network Emergency or Urgent Care, We must receive written notice of your claim within one-hundred eighty (180) days, or as soon thereafter as reasonably possible. Either the Subscriber or Provider of service must claim benefits by sending Us properly completed claim forms itemizing the services or supplies received and the charges. These claim forms must be received by Us within one- hundred eighty (180) calendar days from the date the services or supplies are received. We will not be liable for benefits if We do not receive completed claim forms within this time period. General Claim Filing Guidelines Claim forms must be used; canceled checks or receipts are not acceptable. Claim forms are available by accessing Our web site at xxx.xxxxxxx.xxx by calling the telephone number on the back of Your Identification Card or by writing to Us at the address in the next sentence. Prior to submitting Your member claim form and itemized bill, You should make copies of the documents for Your own records and attach the original bills to the completed member claim form. The bills and the member claim form should be mailed to: Oscar Health Plan of California Attn: Claims 0000 Xxxxxx Xxxx Blvd. PO Box 1279 Culver City, CA 90232 Out-of-Network providers must submit claims within one hundred eighty (180) calendar days following the dates of service unless otherwise mandated by law. A claim received after the one hundred eighty (180) days billing time limit is subject to denial. When You receive health care outside of the United States, You will need to submit an itemized bill and medical records for services rendered. The itemized bill and medical records must be translated into English and include the billed charges. Note: You are responsible, at Your own expense, for obtaining an English language translation of foreign country Provider claims and medical recordsmedicalrecords. Other Charges Copayments and Coinsurance are outlined in the SUMMARY OF BENEFITS. Your Copayment and Coinsurance may be a fixed dollar amount per day, per visit, and/or it may be a percentage of the Negotiated Fee Rate. Important: You are responsible for confirming that the Provider You are seeing or have been referred to see is an In-Network Provider under Your Plan. Unless an exception (listed in the HOW YOUR COVERAGE WORKS section) applies, any claims incurred with a Provider who is not a part of Your Plan’s In-Network Providers, will not be covered. Xxxxx can help You find an In-Network Provider specific to Your Plan by calling customer service at 1-855-Oscar-55 or visit Us at xxx.xxxxxxx.xxx. These amounts are Your financial responsibility. After Your Deductible is satisfied, Copayments are normally paid by You at the time services are performed. If Your Plan contains a Deductible, You must satisfy the In-Network medical Deductible before We will make payment for services You receive, except for certain services as stated in the sections below. Additionally, the medical Deductible is explained in the SUMMARY OF BENEFITS. While Your Coinsurance financial responsibility may also be collected by the Provider at the time services are performed, the Provider may choose to bill You for these services after they have submitted the claim to Us. Cost sharing for services with Copayments is the lesser of the Copayment amount or Negotiated Fee Rate. Described below are Your Coinsurance and Out of Pocket Maximums.