Non-Participating Provider Services. When, in the professional judgment of XxXxx's Medical Director, a Member needs covered Health Care Services or Hospital services which require skills or facilities not available from Participating Providers, and it is in the best interest of the Member to obtain the needed care from a Non-Participating Provider, upon authorization by the Medical Director, payment not to exceed the Maximum Allowable Payment, will be made for such Covered Services rendered by a Non-Participating Provider.
Appears in 19 contracts
Samples: Medical and Hospital Service Contract, Medical and Hospital Service Contract, Medical and Hospital Service Contract
Non-Participating Provider Services. When, in the professional judgment of XxXxx's Medical Director, a Member needs covered Health Care Services or Hospital services which require skills or facilities not available from Participating Providers, and it is in the best interest of the Member to obtain the needed care from a Non-Participating Provider, upon authorization by the Medical Director, payment will be made not to exceed the Maximum Allowable Payment, will be made Payment for such Covered Services rendered by a Non-Participating Provider.
Appears in 4 contracts
Samples: Medical and Hospital Service Contract, Large Group Hmo Plan Medical and Hospital Service Contract, Non Group Medical and Hospital Service Contract
