Common use of New Members In a Course of Treatment Clause in Contracts

New Members In a Course of Treatment. If You are in an ongoing course of treatment with a Non-Participating Provider when Your coverage under this Contract becomes effective, You may be able to receive Covered Services for the ongoing treatment from the Non-Participating Provider for up to 60 days from the effective date of Your coverage under this Contract. In order for You to continue to receive Covered Services for up to 60 days, the Non-Participating Provider must agree to accept as payment Our fees for such services. The Provider must also agree to provide Us necessary medical information related to Your care and to adhere to Our policies and procedures including those for assuring quality of care, obtaining Preauthorization, Referrals, and a treatment plan approved by Us. If the Provider agrees to these conditions, You will receive the Covered Services as if they were being provided by a Participating Provider. You will only be responsible for any applicable in- network Cost-Sharing.

Appears in 3 contracts

Samples: Preferred Provider Organization Contract, Preferred Provider, Preferred Provider Organization Contract

AutoNDA by SimpleDocs

New Members In a Course of Treatment. If You are in an ongoing course of treatment with a Non-Participating Provider when Your coverage under this Contract becomes effective, You may be able to receive Covered Services for the ongoing treatment from the Non-Participating Provider for up to 60 days from the effective date of Your coverage under this Contract. This course of treatment must be for a life- threatening disease or condition or a degenerative and disabling condition or disease. In order for You to continue to receive Covered Services for up to 60 days, the Non-Participating Provider must agree to accept as payment Our fees for such services. The Provider must also agree to provide Us necessary medical information related to Your care and to adhere to Our policies and procedures including those for assuring quality of care, obtaining Preauthorization, Referrals, and a treatment plan approved by Us. If the Provider agrees to these conditions, You will receive the Covered Services as if they were being provided by a Participating Provider. You will only be responsible for any applicable in- network In-Network Cost-Sharing.

Appears in 3 contracts

Samples: Preferred Provider, Preferred Provider, Preferred Provider

New Members In a Course of Treatment. If You are in an ongoing course of treatment with a Nonnon-Participating participating Provider when Your coverage under this Contract Policy becomes effective, You may be able to receive Covered Services for the ongoing treatment from the Non-Participating participating Provider for up to 60 days from the effective date of Your coverage under this ContractPolicy. This course of treatment must be for a life-threatening disease or condition or a degenerative and disabling condition or disease. In order for You to continue to receive Covered Services for up to 60 days, the Non-Participating Non- participating Provider must agree to accept as payment Our fees for such services. The Provider must also agree to provide Us necessary medical information related to Your care and to adhere to Our policies and procedures including those for assuring quality of care, obtaining Preauthorization, Referrals, and a treatment plan approved by Us. If the Provider agrees to these conditions, You will receive the Covered Services as if they were being provided by a Participating Provider. You will only be responsible only for any applicable in- in-network Cost-Sharing.

Appears in 2 contracts

Samples: healthplex.com, healthplex.com

New Members In a Course of Treatment. If You are in an ongoing course of treatment with a Non-Participating Provider when Your coverage under this Contract becomes effective, You may be able to receive Covered Services for the ongoing treatment from the Non-Participating Provider for up to 60 days from the effective date of Your coverage under this Contract. This course of treatment must be for a life-threatening disease or condition or a degenerative and disabling condition or disease. In order for You to continue to receive Covered Services for up to 60 days, the Non-Participating Provider must agree to accept as payment Our fees for such services. The Provider must also agree to provide Us necessary medical information related to Your care and to adhere to Our policies and procedures including those for assuring quality of care, obtaining Preauthorization, Referrals, and a treatment plan approved by Us. If the Provider agrees to these conditions, You will receive the Covered Services as if they were being provided by a Participating Provider. You will only be responsible for any applicable in- network Cost-Sharing.

Appears in 2 contracts

Samples: Preferred Provider, Preferred Provider Organization Contract

New Members In a Course of Treatment. If You are in an ongoing course of treatment with a Non-Participating Provider when Your coverage under this Contract becomes effective, You may be able to receive Covered Services for the ongoing treatment from the Non-Participating Provider for up to 60 days from the effective date of Your coverage under this Contract. This course of treatment must be for a life- threatening disease or condition or a degenerative and disabling condition or disease. In order for You to continue to receive Covered Services for up to 60 days, the Non-Participating Provider must agree to accept as payment Our fees for such services. The Provider must also agree to provide Us necessary medical information related to Your care and to adhere to Our policies and procedures including those for assuring quality of care, obtaining Preauthorization, Referrals, and a treatment plan approved by Us. If the Provider agrees to these conditions, You will receive the Covered Services as if they were being provided by a Participating Provider. You will only be responsible for any applicable in- in-network Cost-Sharing.

Appears in 1 contract

Samples: Preferred Provider Organization Contract

AutoNDA by SimpleDocs

New Members In a Course of Treatment. If You are in an ongoing course of treatment with a Non-Participating Provider when Your coverage under this Contract becomes effective, You may be able to receive Covered Services for the ongoing treatment from the Non-Participating Provider for up to 60 days from the effective date of Your coverage under this Contract. This course of treatment must be for a life-threatening disease or condition or a degenerative and disabling condition or disease. In order for You to continue to receive Covered Services services for up to 60 days, the Non-Non- Participating Provider must agree to accept as payment Our fees for such services. The Provider must also agree to provide Us necessary medical information related to Your care and to adhere to Our policies and procedures including those for assuring quality of care, obtaining Preauthorization, Referrals, and a treatment plan approved by Us. If the Provider agrees to these conditions, You will receive the Covered Services services as if they were being provided by a Participating Provider. You will only be responsible for any applicable in- in-network Cost-Sharing.

Appears in 1 contract

Samples: Preferred Provider Organization Contract

New Members In a Course of Treatment. If You are in an ongoing course of treatment with a Non-Participating Provider when Your coverage under this Contract becomes effective, You may be able to receive Covered Services for the ongoing treatment from the Non-Participating Provider for up to 60 days from the effective date of Your coverage under this Contract. This course of treatment must be for a life-threatening disease or condition or a degenerative and disabling condition or disease. In order for You to continue to receive Covered Services services for up to 60 days, the Non-days Non- Participating Provider must agree to accept as payment Our fees for such services. The Provider must also agree to provide Us necessary medical information related to Your care and to adhere to Our policies and procedures including those for assuring quality of care, obtaining Preauthorization, Referrals, and a treatment plan approved by Us. If the Provider agrees to these conditions, You will receive the Covered Services services as if they were being provided by a Participating Provider. You will only be responsible for any applicable in- in-network Cost-Sharing.

Appears in 1 contract

Samples: www.cdphp.com

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!