No Balance Billing. No Enrollee may be balance billed by any provider for any reason for covered services.
No Balance Billing. AHERF hereby agrees that in no event, including but not limited to, non-payment by a Member Company, a Member Company insolvency or breach of the Agreement, shall AHERF bill, xxarge or collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against, Covered Individuals or persons other than a Member Company acting on their behalf for Covered Services. This Section shall not prohibit collection of Copayments, Coinsurance, Deductibles or Financial Penalties made in accordance with the terms of the applicable Covered Individual's contract with a Member Company nor billing for non-Covered Service for which Covered Individuals have had prior notification and approved. AHERF further agrees that: (i) the no balance billing provision herein shall survive the termination of the Agreement regardless of the cause giving rise to termination and shall be construed to be for the benefit of Covered Individuals; and (ii) this no balance billing provision supersedes any oral or written contrary Agreement now existing or hereafter entered between AHERF and a Covered Individual or a person acting on his/her behalf. Any modification, addition or deletion to the provisions of this Section shall become effective on a date no earlier that sixty (60) days after the Pennsylvania Secretary of Health has received written notice of such proposed change.
No Balance Billing. No Participant may be balance billed by any provider for any reason for Covered Items and Services.
No Balance Billing. No enrollee may be balance billed by any provider for any reason for Demonstration covered services or flexible benefits.
No Balance Billing. Participating dentists agree not to charge any difference between their fees and Delta Dental’s allowed fees. Because participating dentists accept Delta Dental’s allowed fees for services, you will typically pay less when you visit a participating dentist.
No Balance Billing. Practitioner agrees that he/she will hold harmless and will not seek reimbursement from Members for Covered Services provided by Practitioner, other than for a Copayment. Practitioner agrees that: (i) this provision supercedes any oral or written contrary agreement previously entered into between Practitioner and Member or anyone acting on their behalf; and (ii) Practitioner shall abide by the terms of this provision in the event of non- payment by VBH or Payor for any reason, including, but not limited to voluntary or involuntary bankruptcy proceedings involving VBH or Payor. In the event that Practitioner violates this provision, VBH shall have the right to take any action it deems appropriate including, but not limited to, legal action. Practitioner agrees that it will be responsible for paying for any legal or other expense incurred by VBH related to such action and that VBH will also have a right to offset any such surcharges or expenses against any other payments that may be due under this Agreement.
No Balance Billing. Pursuant to OAC rule 5160-26-05, Provider shall not bill Covered Persons any amount greater than would be owed if the entity provided the Covered Services directly (i.e., no balance billing). (SC App. B., §4.h.)
No Balance Billing. Dentist agrees to accept the Allowed Fee as payment in full and agrees not to balance xxxx the Covered Person for any difference between Dentist’s normal charge and the Allowed Fee as determined under this agreement. Dentist shall look solely to Sponsors for compensation for Covered Services provided to Covered Persons and under no circumstances shall Dentist render a xxxx or charge to any Covered Person except:
(i) for Cost Shares; or
(ii) for non-covered services unless such services are determined by Sponsor to be non-covered services due to utilization management, utilization review or similar Medical Necessity review in which case Dentist shall not xxxx Anthem Blue Cross, Sponsor or Covered Person; or
(iii) for services provided after the individual ceases to be a Covered Person.
No Balance Billing. Providers may not xxxx Members any amount greater than would be owed if Health Plan provided the services directly (i.e., no balance billing by Providers is permitted.
