Common use of Non-Covered Services Clause in Contracts

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.

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.Covered