Non-Participating Healthcare Providers Outside BCBSM's Service Area. 1. Member Liability Calculation When covered healthcare services are provided outside of BCBSM's service area by non-participating healthcare providers, the amount(s) a Member pays for such services will generally be based on either the Host Blue's non-participating healthcare provider local payment or the pricing arrangements required by applicable state law. In these situations, the Member may be responsible for the difference between the amount that the non-participating healthcare provider bills and the payment BCBSM will make for the covered services as set forth in this paragraph.
Appears in 5 contracts
Samples: Group Enrollment and Coverage Agreement, Group Enrollment and Coverage Agreement, Group Enrollment and Coverage Agreement
