Non-Covered Services. MCOs are not permitted to provide Medicaid excluded services that include, but are not limited to, the following:
1. All non-medically necessary services;
2. Sterilization of a mentally incompetent or institutionalized individual;
3. Except in an emergency, inpatient hospital tests that are not ordered by the attending physician or other licensed practitioner, acting within the scope of practices, who is responsible for the diagnosis or treatment of a particular patient’s condition;
4. All organ transplants, except for those specified in Appendix A; 5. Treatments for infertility5 and for the reversal of sterilization;
Non-Covered Services. The Contractor shall refer Members to Providers enrolled in the Medicaid Fee-for- Service delivery system for all Medically Necessary Services not covered by the Contractor under the MississippiCAN Program. The Contractor shall have written policies and procedures for the referral of Members for non-covered services, which shall provide for the smooth transition to Out-of-network Providers and assistance to Members in obtaining a new PCP, if appropriate. These procedures shall be applicable to the referral of Members to Out-of- network Providers, as necessary, upon Disenrollment, regardless of the reasons for Disenrollment.
Non-Covered Services. Patient understands and acknowledges that Patient is responsible for any charges incurred for health care services performed outside of the physical office space location as set forth above, including, but not limited to, emergency room visits, hospital and specialist care, and imaging and lab tests performed by third parties. Patient shall also be responsible for any charges incurred for health care services provided by the Practice not specifically described in Section 1 hereof. THE PRACTICE STRONGLY ENCOURAGES THE PATIENT TO MAINTAIN HEALTH INSURANCE DURING THE TERM OF THIS MEMBERSHIP AGREEMENT TO COVER SERVICES THAT ARE NOT PROVIDED UNDER THIS MEMBERSHIP AGREEMENT. PATIENT SHOULD PURCHASE HEALTH INSURANCE TO COVER, AT MINIMUM, UNPREDICTABLE AND CATASTROPHIC EXPENSES.
Non-Covered Services. Before a Provider provides items or services to a Member that are not Covered Services, Provider shall (a) inform the Member of the specific items or services that are not Covered Services and that they will not be paid for by Health Plan, and (b) obtain the Member’s written agreement to pay for such specific items or services after being so advised. Provider may contact Health Plan to determine if an item or service is a Covered Service.
Non-Covered Services. Patient understands and acknowledges that Patient is responsible for any charges incurred for health care services performed outside of the physical office space location as set forth above, including, but not limited to, emergency room visits, hospital and specialist care, and imaging and lab tests performed by third parties. Patient shall also be responsible for any charges incurred for health care services provided by the Practice but not specifically described on Exhibit A.
Non-Covered Services. Nothing in this Agreement shall be construed to prohibit or otherwise restrict Provider, its employees and agents from advising or advocating on behalf of Member about Member’s health status, medical care, or treatment options; the risks, benefits, and consequences of treatment or non-treatment; or the opportunity for Member to refuse treatment or to express preferences about future treatment decisions, regardless of Health Plan benefit coverage limitations. The parties recognize that Members may consent to receive services that are not Covered Services or are not authorized by Health Plan and therefore, may be payable by Member. Provider is responsible for confirming all proposed services as Covered Services and for verifying proper authorization of such services prior to treating Member. When proposed services are not payable by Health Plan, Provider must inform Member in advance and should document in writing Member’s consent to be billed for the services.
Non-Covered Services. Services not covered under the applicable Benefit Plan are not subject to the rates or discounts of this Agreement. Facility may seek and collect payment from a Customer for such services (provided that Facility obtained the Customer’s written consent).
Non-Covered Services. As specified in section A.2.10 of the CRA, Provider acknowledges and agrees that, except as authorized pursuant to section A.2.6.5 of the CRA, and in accordance with applicable the Division of TennCare rules and regulations at 0000.00.00.00 and 0000.00.00.00, Health Plan and Subcontractor shall not pay for non-Covered Services.
Non-Covered Services. No benefits are payable pursuant to this Agreement which are not otherwise payable by Member's MA PPO Benefit Contract.
Non-Covered Services. With respect to payment for non-covered services or for self- referrals by a Covered Person without following Health Plan or Subcontractor procedures, Provider may not bill a Covered Person directly unless Provider has informed the Covered Person of the costs for such non-covered services prior to rendering such services and has obtained the Covered Person’s prior written, signed consent agreeing to pay for such services on a completed Advance Beneficiary Notice of Non-coverage, which includes the cost of the procedure and payment terms, provided however, if Provider fails to follow Health Plan or Subcontractor’s procedures which results in nonpayment, Provider may not bill the Covered Person. The form of such written consent shall comply with any requirements of the State Contract and all applicable laws or regulations.
