Common use of Other Provider Charges Clause in Contracts

Other Provider Charges. The Plan does not provide Benefits for physician or other practitioners’ charges for consulting with Members by telephone, fax, e-mail or other consultation or medical management service not involving direct care with the Member. This includes, but is not limited to, the following: surcharges for furnishing and/or receiving medical records and reports; charges for doing research with Providers not directly responsible for your care; charges that are not documented in Provider records; charges for an outside laboratory or shop for services in connection with an order involving devices (e.g. prosthetic, orthotic) which are manufactured by that laboratory or shop, but which are designed to be fitted and adjusted by the attending physician; and charges related to membership, administrative, or access fees by physicians or other Providers (e.g. education brochures, providing test results to Members). This exclusion includes over-the-counter batteries for medically necessary devices.

Other Provider Charges. The Plan does not provide Benefits for physician or other practitioners’ charges for consulting with Members by telephone, fax, e-mail or other consultation or medical management service not involving direct care with the Member. This includes, but is not limited to, the following: surcharges for furnishing and/or receiving medical records and reports; charges for doing research with Providers not directly responsible for your care; charges that are not documented in Provider records; charges for an outside laboratory or shop for services in connection with an order involving devices (e.g. prosthetic, orthotic) which are manufactured by that laboratory or shop, but which are designed to be fitted and adjusted by the attending physician; and charges related to membership, administrative, or access fees by physicians or other Providers (e.g. education brochures, providing test results to Members). This exclusion includes over-the-over the counter batteries for medically necessary devices.

Other Provider Charges. The Plan does not provide Benefits for physician or other practitioners’ charges for consulting with Members by telephone, fax, e-mail e‐mail or other consultation or medical management service not involving direct care with the Member. This includes, but is not limited to, the following: surcharges for furnishing and/or receiving medical records and reports; charges for doing research with Providers not directly responsible for your care; charges that are not documented in Provider records; charges for an outside laboratory or shop for services in connection with an order involving devices (e.g. prosthetic, orthotic) which are manufactured by that laboratory or shop, but which are designed to be fitted and adjusted by the attending physician; and charges related to membership, administrative, or access fees by physicians or other Providers (e.g. education brochures, providing test results to Members). This exclusion includes over-the-counter over‐the‐counter batteries for medically necessary devices.