Payments from Members. Members utilizing medical services which are not medically necessary or who obtain covered services from Non-Contracted Providers without Prior Authorization and referral by the Contractor shall be responsible for payment in full of all costs associated with such services. The Contractor shall not require any co-payments, deductibles or other cost sharing by Members for covered services under this Contract, nor shall the Contractor charge Members for missed appointments. Members with coverage from Third Party Liability/Resources shall not be required to pay any portion of the medical fees for covered services under this contract, even during the deductible periods of these other health plans. The Member may be responsible for non-covered item(s) and/or service(s), only if, the Provider ensures that written documentation in compliance with the Advance Beneficiary Notification (ABN) is received from the Member that an item(s) or service(s) rendered is a non-covered item and/or service(s) and that the Member will be financially responsible for the item(s) and/or service(s).
Payments from Members. Members utilizing medical services which are not medically necessary or who obtain covered services from Non-Contracted Providers without Prior Authorization and referral by Contractor shall be responsible for payment in full of all costs associated with such services. The Member may be responsible for non-covered item(s) and/or service(s), only if, the provider ensures that written documentation in compliance with the Advance Beneficiary Notification (ABN) is sent to the Member that an item(s) or service(s) rendered is a non-covered item and/or service(s) and that the Member will be financially responsible for the item(s) and/or service(s).
Payments from Members. Members utilizing medical services which are not medically necessary or who obtain covered services from Non-Contracted Providers without Prior Authorization and referral by the Contractor shall be responsible for payment in full of all costs associated with such services. The Contractor shall not require any co-payments, deductibles or other cost sharing by Members for covered services under this Contract, nor shall the Contractor charge Members for missed appointments. Members with coverage from Third Party Liability/Resources shall not be required to pay any portion of the medical fees for covered services under this contract, even during the deductible periods of these other health plans. If applicable, any cost sharing imposed on Medicaid enrollees will be in accordance with Medicaid Fee-for-Service requirements at 42 C.F.R. § 447.50 through 42 C.F.R. § 447.60. Additionally, the Contractor must exempt from premiums any Indian who is eligible to receive, is currently receiving, or has received an item or service furnished by an Indian health care provider or through referral under contract health services, if applicable The Member may be responsible for non-covered item(s) and/or service(s), only if, the Provider ensures that written documentation in compliance with the Advance Beneficiary Notification (ABN) is received from the Member that an item(s) or service(s) rendered is a non-covered item and/or service(s) and that the Member will be financially responsible for the item(s) and/or service(s).
