No-Gag Clause Clause Samples
No-Gag Clause. Nothing in these Regulations shall be construed to limit or prohibit Preferred Provider’s right to discuss, and Preferred Provider may freely discuss, with any Member, or, where applicable, on behalf of such Member with such Member’s representative: (a) the process that Blue Shield uses or proposes to use to deny payment for a health care service; (b) medically necessary and appropriate care available to such Member that is within Preferred Provider’s scope of practice, including information regarding the nature of treatment, risks of treatment, alternative treatments, or the availability of alternate therapies, consultation or tests, regardless of benefit coverage limitations under the terms of the Member’s Managed Care Plan; and (c) the decision of Blue Shield to deny payment for a health care service.
No-Gag Clause. Nothing in these Regulations shall be construed to limit or prohibit Government Sponsored Programs Provider’s right to discuss, and Government Sponsored Programs Provider may freely discuss, with any Member, or, where applicable, on behalf of such Member with such Member’s representative: (a) the process that Blue Shield uses or proposes to use to deny payment for a health care service; (b) medically necessary and appropriate care available to such Member that is within Government Sponsored Programs Provider’s scope of practice, including information regarding the nature of treatment, risks of treatment, alternative treatments, or the availability of alternate therapies, consultation or tests, regardless of benefit coverage limitations under the terms of the Member’s Managed Care Plan; and (c) the decision of Blue Shield to deny payment for a health care service.
No-Gag Clause. Nothing in these Regulations shall be construed to limit or prohibit Professional Provider’s right to discuss, and Professional Provider may freely discuss, with any Member, or, where applicable, on behalf of such Member with such Member’s representative: (a) the process that Highmark or Health Plan uses or proposes to use to deny payment for a health care service; (b) medically necessary and appropriate care available to such Member that is within Professional Provider’s scope of practice, including information regarding the nature of treatment, risks of treatment, alternative treatments, or the availability of alternate therapies, consultation or tests, regardless of benefit coverage limitations under the terms of the Member’s Act 146 Product; and (c) the decision of Highmark or Health Plan to deny payment for a health care service.