Common use of Out-of-Network Providers Clause in Contracts

Out-of-Network Providers. In the event that the Physician of a new Enrollee who is in an active, ongoing course of treatment or is in the third trimester of pregnancy is not an Affiliated Provider, Contractor will permit such Enrollee to continue an ongoing course of treatment with such Physician for up to ninety (90) days or through the postpartum period, or as otherwise required by Section 25 of the Managed Care Reform and Patients Rights Act only if the out-of-network Physician agrees to provide such ongoing course of treatment, and if such out-of-network Physician agrees to: (i) accept reimbursement at Contractor’s established rates based on a review of the level of services provided, (ii) adhere to Contractor’s QA requirements, (iii) provide necessary medical information related to health care, and (iv) adhere to Contractor’s policies and procedures, including, but not limited to, procedures regarding Referrals.