Common use of No Guarantee of Payment Clause in Contracts

No Guarantee of Payment. A Recommended Clinical Review is a determination of the Medical Necessity of a proposed service, but it is not a guarantee of benefits or payment of benefits by BCBSTX. Actual availability of benefits is subject to eligibility and the other terms, conditions, limitations, and exclusions of this Plan. Even if the service has been approved on Recommended Clinical Review, coverage or payment can be affected for reasons other than Medical Necessity. For example, You may have become ineligible as of the date of service or the Member’s benefits may have changed as of the date of service.