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

Out-of-Network Responsibility. If the PIHP is unable to provide necessary medical services covered under the contract to a particular beneficiary the PIHP must adequately and timely cover these services out of network for the beneficiary, for as long as the entity is unable to provide them within the network.

Out-of-Network Responsibility. If the PIHP is unable to provide necessary medical services covered under the contract to a particular beneficiary the PIHP must adequately and timely cover these services out of network for the beneficiary, for as long as the entity is unable to provide them within the network. Since there is no cost to the beneficiary for the PIHP’s in-network services, there may be no cost to beneficiary for medically- necessary specialty services provided out-of-network.

Out-of-Network Responsibility. If the PIHP is unable to provide necessary medical services covered under the contract to a particular beneficiary the PIHP must adequately and timely cover these services out of network for the beneficiary, for as long as the entity is unable to provide them within the network. Since there is no cost to the beneficiary for the PIHP’s in-network services, there may be no cost to beneficiary for medically-necessary specialty services provided out-of-network.