Non-Participating Professional Provider and Non-Contracting Supplier (outside Pennsylvania Sample Clauses

Non-Participating Professional Provider and Non-Contracting Supplier (outside Pennsylvania the Provider’s Reasonable Charge is the usual, reasonable and customary (UCR) allowance. The member will be responsible for any difference between the non-participating professional provider’s or non- contracting supplier’s billed charge and the Plan’s payment. However, the Plan reserves the right to establish threshold amounts at which the Plan may pay non- participating professional providers or non-contracting suppliers at their billed charge. In this instance, the Provider’s Reasonable Charge for non-participating professional providers or non-contracting suppliers will be the billed charge and there will be no resulting liability to the member.
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Non-Participating Professional Provider and Non-Contracting Supplier (outside Pennsylvania the Provider’s Reasonable Charge is the Usual, Reasonable and Customary (UCR)
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