No Billing of Members. Physician may not under any circumstances bill a Plan Member for any Covered Services except to collect any co-payments or deductible provided for under a Health Benefit Program. All co-payments or deductibles should, whenever possible, be collected by Physician at the time services are rendered, and Physician shall report to the Los Alamos PHO, upon request, all co-payments and deductibles received by Physician hereunder. Physician shall be solely responsible for billing and collecting such co-payrnents and deductibles. Physician shall not maintain any action at law or equity against Plan Members to collect sums owed to Physician by the Los Alamos PHO, Plan, or otherwise for Covered Services under this Agreement. Physician may bill a Plan Member for any non-Covered Services which Physician may provide to a Plan Member only if Physician has obtained a written acknowledgement of financial responsibility from the Plan Member prior to the time such non-Covered Services are provided. Physician shall provide Los Alamos PHO with a copy of said acknowledgement upon request. Physician shall further comply with all requirements of a Plan for billing and collection from Plan Members, as set forth in the Los Alamos PHO Agreement or other Plan documents.
No Billing of Members. Except as specifically provided for in this Section, Provider agrees to seek payment from only Health Plan, or a Subcontracted Plan if applicable pursuant to the terms of Section 2.12(c), for all Covered Services provided to a Member. In no event, including but not limited to, nonpayment by Health Plan or a Subcontracted Plan, insolvency by Health Plan or a Subcontracted Plan, or breach of the Agreement, shall Provider, or any person acting on Provider’s behalf, bill, charge, collect a deposit or surcharge from, seek compensation from, maintain an action in law, or have any other recourse against a Member, a person acting on the Member’s behalf, or a Government Agency for Covered Services provided pursuant to this Agreement. No co-payments, deductibles, or co-insurance obligations may be collected by a provider for any Medi-Cal Member. The Medi-Cal Program does not allow cost-sharing. Provider shall ensure that its subcontractors comply with this Section, including the following: Provider may seek payment from Member for services that are not Covered Services under the terms of this Agreement provided the payment is not for otherwise Covered Services which Health Plan determined not to be payable under the terms of this Agreement and provided the Member signs a written waiver that meets the following criteria:
No Billing of Members. The obligation of payment under the Agreement is solely that of Payor and not that of Member. Payment as provided under the Agreement, together with any copayment, deductible or coinsurance for which the Member is responsible under the Benefit Plan, is payment in full for a Covered Service. Provider will not seek to recover, and will not accept any payment from Member or anyone acting in their behalf, in excess of such payment in full, regardless of whether such amount is less than Provider’s billed charge or customary charge. In no event, including, but not limited to, non-payment by Payor for Covered Services rendered to Members by Provider, insolvency of Payor, or breach by UBH of any term or condition of the Agreement, shall Provider bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against any Member, persons acting on behalf of the Member, or the employer or group contract holder for Covered Services eligible for reimbursement under the Agreement; provided, however, that Provider may collect from the Member any copayments, deductibles or coinsurance for which the Member is responsible under the Benefit Plan or charges for services not covered under the Member's Benefit Plan. The provisions of this section shall: (a) apply to all Covered Services rendered while the Agreement is in force; (b) with respect to Covered Services rendered while the Agreement is in force, survive the termination of the Agreement regardless of the cause of termination; (c) be construed to be for the benefit of the Members; and (d) supersede any oral or written agreement, existing or subsequently entered into, between Provider and a Member or person acting on a Member's behalf, that requires the Member to pay for such Covered Services. Should Provider collect or attempt to collect from Member any money for Covered Services provided by Provider to Member other than any copayment, deductible or coinsurance for which the Member is responsible under the Benefit Plan, Provider may be subject to a civil money penalty imposed by the West Virginia Commissioner of Insurance pursuant to West Virginia Code Annotated § 33-25A-23a.
No Billing of Members. (Member Hold Harmless Provision). With the exception of Member Expenses and charges for non-Covered Services delivered, Provider or agent, trustee, or assignee thereof, shall in no event, including, without limitation, non-payment by UBH or Payor, insolvency of UBH or Payor, or breach of this Agreement, bill, charge, request payments, collect a deposit from, seek compensation or remuneration or reimbursement from, or have any recourse against any Member or any person (other than UBH or Payor) acting on behalf of any Member or attempt to do any of the foregoing for Covered Services provided or arranged pursuant to this Agreement. Provider agrees that the contracted rate for Covered Services set forth in the Agreement is the total amount due for such services and UBH's Members are not responsible for amounts above the contracted rate provided for in this Agreement.
No Billing of Members
