Common use of Preferred Bariatric Surgery Services Provider Clause in Contracts

Preferred Bariatric Surgery Services Provider. a Pre- ferred Hospital or a Physician Member that has contracted with Blue Shield of California to furnish bariatric surgery Services and accept reimbursement at negotiated rates, and that has been designated as a contracted bariatric surgery Services provider by Blue Shield of California. Preferred Dialysis Center – a dialysis services facility which has contracted with Blue Shield of California to pro- vide dialysis services on an Outpatient basis and accept xxxx- bursement at negotiated rates. Preferred Hospital — a Hospital which has contracted with Blue Shield of California to furnish Services and accept re- imbursement at negotiated rates, and which has been desig- nated as a Preferred Hospital by Blue Shield of California. Preferred Physicians — a Physician who has agreed to ac- cept Blue Shield of California's payment, plus Subscriber payments of any applicable Deductible and/or Copayments as payment-in-full for covered Services. Please refer to the Summary of Benefits for Copayment information Preferred Provider - A Preferred Provider is a Participating Provider contracted with Blue Shield of California to furnish Services and to accept Blue Shield of California's payment, except for applicable Deductibles, copayments, or amounts in excess of specified benefit maximums, and except as provid- ed under the section entitled Preventive Care Benefits. Note, for Participating Providers for Mental Health Services, see the Mental Health Service Administrator (MHSA) Partici- pating Providers definitions. Skilled Nursing Facility — a facility licensed by the Cali- fornia Department of Health Services as a "Skilled Nursing Facility" or any similar institution licensed under the laws of any other state, territory, or foreign country. All Other Definitions Whenever any of the following terms are capitalized in this booklet, the terms will have the meaning as indicated below: Accidental Injury — definite trauma resulting from a sud- den, unexpected and unplanned event, occurring by chance, caused by an independent external source. Activities of Daily Living (ADL) — mobility skills required for independence in normal everyday living. Recreational, leisure, or sports activities are not included. Acute Care — care rendered in the course of treating an ill- ness, injury or condition marked by a sudden onset or change of status requiring prompt attention, which may include hos- pitalization, but which is of limited duration and which is not expected to last indefinitely. Agreement — this contract, the appendices, all endorsements to it, and all applications for coverage and health statements. Allowable Amount — the Blue Shield of California Allow- ance (as defined below) for the Service (or Services) ren- dered, or the provider's billed charge, whichever is less. The Blue Shield of California Allowance, unless otherwise speci- fied for a particular Service elsewhere in this Agreement, is:

Preferred Bariatric Surgery Services Provider. a Pre- ferred Hospital or a Physician Member that has contracted with Blue Shield of California to furnish bariatric surgery Services and accept reimbursement at negotiated rates, and that has been designated as a contracted bariatric surgery Services provider by Blue Shield of California. Preferred Dialysis Center – a dialysis services facility which has contracted with Blue Shield of California to pro- vide dialysis services on an Outpatient basis and accept xxxx- bursement at negotiated rates. Preferred Hemophilia Infusion Provider — a provider that has contracted with Blue Shield to furnish blood factor re- placement products and services for in-home treatment of blood disorders such as hemophilia and accept reimburse- ment at negotiated rates, and that has been designated as a contracted Hemophilia Infusion Provider by Blue Shield. Preferred Hospital — a Hospital which has contracted with Blue Shield of California to furnish Services and accept re- imbursement at negotiated rates, and which has been desig- nated as a Preferred Hospital by Blue Shield of California. Preferred Physicians — a Physician who has agreed to ac- cept Blue Shield of California's payment, plus Subscriber payments of any applicable Deductible and/or Copayments as payment-in-full for covered Services. Please refer to the Summary of Benefits for Copayment information Preferred Provider - A Preferred Provider is a Participating Provider contracted with Blue Shield of California to furnish Services and to accept Blue Shield of California's payment, except for applicable Deductibles, copayments, or amounts in excess of specified benefit maximums, and except as provid- ed under the section entitled Preventive Care Benefits. Note, for Participating Providers for Mental Health Services, see the Mental Health Service Administrator (MHSA) Partici- pating Providers definitions. Preferred Physicians — a Physician who has agreed to ac- cept Blue Shield of California's payment, plus Subscriber payments of any applicable Deductible and/or Copayments as payment-in-full for covered Services. Please refer to the Summary of Benefits for Copayment information Skilled Nursing Facility — a facility licensed by the Cali- fornia Department of Health Services as a "Skilled Nursing Facility" or any similar institution licensed under the laws of any other state, territory, or foreign country. All Other Definitions Whenever any of the following terms are capitalized in this booklet, the terms will have the meaning as indicated below: Accidental Injury — definite trauma resulting from a sud- den, unexpected and unplanned event, occurring by chance, caused by an independent external source. Activities of Daily Living (ADL) — mobility skills required for independence in normal everyday living. Recreational, leisure, or sports activities are not included. Acute Care — care rendered in the course of treating an ill- ness, injury or condition marked by a sudden onset or change of status requiring prompt attention, which may include hos- pitalization, but which is of limited duration and which is not expected to last indefinitely. Agreement — this contract, the appendices, all endorsements to it, and all applications for coverage and health statements. Allowable Amount — the Blue Shield of California Allow- ance (as defined below) for the Service (or Services) ren- dered, or the provider's billed charge, whichever is less. The Blue Shield of California Allowance, unless otherwise speci- fied for a particular Service elsewhere in this Agreement, is:

Preferred Bariatric Surgery Services Provider. a Pre- ferred Hospital or a Physician Member that has contracted with Blue Shield of California to furnish bariatric surgery Services and accept reimbursement at negotiated rates, and that has been designated as a contracted bariatric surgery Services provider by Blue Shield of California. Preferred Dialysis Center – a dialysis services facility which has contracted with Blue Shield of California to pro- vide dialysis services on an Outpatient basis and accept xxxx- bursement re- imbursement at negotiated rates. Preferred Hospital — a Hospital which has contracted with Blue Shield of California to furnish Services and accept re- imbursement ac- cept reimbursement at negotiated rates, and which has been desig- nated designated as a Preferred Hospital by Blue Shield of CaliforniaCali- fornia. Preferred Provider — a Preferred Physician, a Preferred Hospital, or other Participating Provider. Note: for Partici- pating Providers for Mental Health Services see the Mental Health Service Administrator (MHSA) Participating Provid- er definition above. Preferred Physicians — a – A Physician who has agreed to ac- cept Blue Shield of California's ’s payment, plus Subscriber payments of any applicable Deductible and/or Copayments as payment-in-full for covered Services. Please refer to the Summary of Benefits for Copayment information Preferred Provider - A Preferred Provider is a Participating Provider contracted with Blue Shield of California to furnish Services and to accept Blue Shield of California's payment, except for applicable Deductibles, copayments, or amounts in excess of specified benefit maximums, and except as provid- ed under the section entitled Preventive Care Benefits. Note, for Participating Providers for Mental Health Services, see the Mental Health Service Administrator (MHSA) Partici- pating Providers definitionsinformation. Skilled Nursing Facility — a facility licensed by the Cali- fornia Department of Health Services as a "Skilled Nursing Facility" or any similar institution licensed under the laws of any other state, territory, or foreign country. All Other Definitions Whenever any of the following terms are capitalized in this booklet, the terms will have the meaning as indicated belowbe- low: Accidental Injury — definite trauma resulting from a sud- den, unexpected and unplanned event, occurring by chance, caused by an independent external source. Activities of Daily Living (ADL) — mobility skills required re- quired for independence in normal everyday living. RecreationalRecrea- tional, leisure, or sports activities are not included. Acute Care — care rendered in the course of treating an ill- nessillness, injury or condition marked by a sudden onset or change of status requiring prompt attention, which may include hos- pitalizationin- clude hospitalization, but which is of limited duration and which is not expected to last indefinitely. Agreement — this contract, the appendices, all endorsements endorse- ments to it, and all applications for coverage and health statements. Allowable Amount — the Blue Shield of California Allow- ance (as defined below) for the Service (or Services) ren- dered, or the provider's billed charge, whichever is less. The Blue Shield of California Allowance, unless otherwise speci- fied specified for a particular Service elsewhere in this AgreementAgree- ment, is:

Preferred Bariatric Surgery Services Provider. a Pre- ferred Hospital or a Physician Member that has contracted with Blue Shield of California to furnish bariatric surgery Services and accept reimbursement at negotiated rates, and that has been designated as a contracted bariatric surgery Services provider by Blue Shield of California. Preferred Dialysis Center – a dialysis services facility which has contracted with Blue Shield of California to pro- vide dialysis services on an Outpatient basis and accept xxxx- bursement at negotiated rates. Preferred Hospital — a Hospital which has contracted with Blue Shield of California to furnish Services and accept re- imbursement at negotiated rates, and which has been desig- nated as a Preferred Hospital by Blue Shield of California. Preferred Physicians — a Physician who has agreed to ac- cept Blue Shield of California's payment, plus Subscriber payments of any applicable Deductible and/or Copayments as payment-in-full for covered Services. Please refer to the Summary of Benefits for Copayment information Preferred Provider - A Preferred Provider is a Participating Provider contracted with Blue Shield of California to furnish Services and to accept Blue Shield of California's payment, except for applicable Deductibles, copayments, or amounts in excess of specified benefit maximums, and except as provid- ed under the section entitled Preventive Care Benefits. Note, : for Participating Providers for Mental Health Services, see the Mental Health Service Administrator (MHSA) Partici- pating Providers definitions. Prosthesis — an artificial part, appliance, or device used to replace a missing part of the body. Skilled Nursing Facility — a facility licensed by the Cali- fornia Department of Health Services as a "Skilled Nursing Facility" or any similar institution licensed under the laws of any other state, territory, or foreign country. All Other Definitions Whenever any of the following terms are capitalized in this booklet, the terms will have the meaning as indicated below: Accidental Injury — definite trauma resulting from a sud- den, unexpected and unplanned event, occurring by chance, caused by an independent external source. Activities of Daily Living (ADL) — mobility skills required for independence in normal everyday living. Recreational, leisure, or sports activities are not included. Acute Care — care rendered in the course of treating an ill- ness, injury or condition marked by a sudden onset or change of status requiring prompt attention, which may include hos- pitalization, but which is of limited duration and which is not expected to last indefinitely. Agreement — this contract, the appendices, all endorsements to it, and all applications for coverage and health statements. Allowable Amount — the Blue Shield of California Allow- ance (as defined below) for the Service (or Services) ren- dered, or the provider's billed charge, whichever is less. The Blue Shield of if California Allowance, unless otherwise speci- fied for a particular Service elsewhere in this Agreement, is:

Preferred Bariatric Surgery Services Provider. a Pre- ferred Hospital or a Physician Member that has contracted with Blue Shield of California to furnish bariatric surgery Services and accept reimbursement at negotiated rates, and that has been designated as a contracted bariatric surgery Services provider by Blue Shield of California. Preferred Dialysis Center – a dialysis services facility which has contracted with Blue Shield of California to pro- vide dialysis services on an Outpatient basis and accept xxxx- bursement at negotiated rates. Preferred Hospital — a Hospital which has contracted with Blue Shield of California to furnish Services and accept re- imbursement at negotiated rates, and which has been desig- nated as a Preferred Hospital by Blue Shield of California. Preferred Physicians — a Physician who has agreed to ac- cept Blue Shield of California's payment, plus Subscriber payments of any applicable Deductible and/or Copayments as payment-in-full for covered Services. Please refer to the Summary of Benefits for Copayment information Preferred Provider - A Preferred Provider is a Participating Provider contracted with Blue Shield of California to furnish Services and to accept Blue Shield of California's payment, except for applicable Deductibles, copayments, or amounts in excess of specified benefit maximums, and except as provid- ed under the section entitled Preventive Care Benefits. Note, for Participating Providers for Mental Health Services, see the Mental Health Service Administrator (MHSA) Partici- pating Providers definitions. Skilled Nursing Facility — a facility licensed by the Cali- fornia Department of Health Services as a "Skilled Nursing Facility" or any similar institution licensed under the laws of any other state, territory, or foreign country. All Other Definitions Whenever any of the following terms are capitalized in this booklet, the terms will have the meaning as indicated below: Accidental Injury — definite trauma resulting from a sud- den, unexpected and unplanned event, occurring by chance, caused by an independent external source. Activities of Daily Living (ADL) — mobility skills required for independence in normal everyday living. Recreational, leisure, or sports activities are not included. Acute Care Care— care rendered in the course of treating an ill- ness, injury or condition marked by a sudden onset or change of status requiring prompt attention, which may include hos- pitalization, but which is of limited duration and which is not expected to last indefinitely. Agreement — this contract, the appendices, all endorsements to it, and all applications for coverage and health statements. Allowable Amount — the Blue Shield of California Allow- ance (as defined below) for the Service (or Services) ren- dered, or the provider's billed charge, whichever is less. The Blue Shield of California Allowance, unless otherwise speci- fied for a particular Service elsewhere in this Agreement, is:

Preferred Bariatric Surgery Services Provider. a Pre- ferred Hospital or a Physician Member that has contracted with Blue Shield of California to furnish bariatric surgery Services and accept reimbursement at negotiated rates, and that has been designated as a contracted bariatric surgery Services provider by Blue Shield of California. Preferred Dialysis Center – a dialysis services facility which has contracted with Blue Shield of California to pro- vide dialysis services on an Outpatient basis and accept xxxx- bursement at negotiated rates. Preferred Hospital — a Hospital which has contracted with Blue Shield of California to furnish Services and accept re- imbursement at negotiated rates, and which has been desig- nated as a Preferred Hospital by Blue Shield of California. Preferred Physicians — a Physician who has agreed to ac- cept Blue Shield of California's payment, plus Subscriber payments of any applicable Deductible and/or Copayments as payment-in-full for covered Services. Please refer to the Summary of Benefits for Copayment information Preferred Provider - A Preferred Provider is a Participating Provider contracted with Blue Shield of California to furnish Services and to accept Blue Shield of California's payment, except for applicable Deductibles, copayments, or amounts in excess of specified benefit maximums, and except as provid- ed under the section entitled Preventive Care Benefits. Note, for Participating Providers for Mental Health Services, see the Mental Health Service Administrator (MHSA) Partici- pating Providers definitions. Preferred Physicians — a Physician who has agreed to ac- cept Blue Shield of California's payment, plus Subscriber payments of any applicable Deductible and/or Copayments as payment-in-full for covered Services. Please refer to the Summary of Benefits for Copayment information Skilled Nursing Facility — a facility licensed by the Cali- fornia Department of Health Services as a "Skilled Nursing Facility" or any similar institution licensed under the laws of any other state, territory, or foreign country. All Other Definitions Whenever any of the following terms are capitalized in this booklet, the terms will have the meaning as indicated below: Accidental Injury — definite trauma resulting from a sud- den, unexpected and unplanned event, occurring by chance, caused by an independent external source. Activities of Daily Living (ADL) — mobility skills required for independence in normal everyday living. Recreational, leisure, or sports activities are not included. Acute Care — care rendered in the course of treating an ill- ness, injury or condition marked by a sudden onset or change of status requiring prompt attention, which may include hos- pitalization, but which is of limited duration and which is not expected to last indefinitely. Agreement — this contract, the appendices, all endorsements to it, and all applications for coverage and health statements. Allowable Amount — the Blue Shield of California Allow- ance (as defined below) for the Service (or Services) ren- dered, or the provider's billed charge, whichever is less. The Blue Shield of California Allowance, unless otherwise speci- fied for a particular Service elsewhere in this Agreement, is:

Preferred Bariatric Surgery Services Provider. a Pre- ferred Hospital or a Physician Member that has contracted with Blue Shield of California to furnish bariatric surgery Services and accept reimbursement at negotiated rates, and that has been designated as a contracted bariatric surgery Services provider by Blue Shield of California. Preferred Dialysis Center – a dialysis services facility which has contracted with Blue Shield of California to pro- vide dialysis services on an Outpatient basis and accept xxxx- bursement at negotiated rates. Preferred Hospital — a Hospital which has contracted with Blue Shield of California to furnish Services and accept re- imbursement at negotiated rates, and which has been desig- nated as a Preferred Hospital by Blue Shield of California. Preferred Physicians — a Physician who has agreed to ac- cept Blue Shield of California's payment, plus Subscriber payments of any applicable Deductible and/or Copayments as payment-in-full for covered Services. Please refer to the Summary of Benefits for Copayment information Preferred Provider - A Preferred Provider is a Participating Provider contracted with Blue Shield of California to furnish Services and to accept Blue Shield of California's payment, except for applicable Deductibles, copayments, or amounts in excess of specified benefit maximums, and except as provid- ed under the section entitled Preventive Care Benefits. Note, for Participating Providers for Mental Health Services, see the Mental Health Service Administrator (MHSA) Partici- pating Providers definitions. Skilled Nursing Facility — a facility licensed by the Cali- fornia Department of Health Services as a "Skilled Nursing Facility" or any similar institution licensed under the laws of any other state, territory, or foreign country. All Other Definitions Whenever any of the following terms are capitalized in this booklet, the terms will have the meaning as indicated below: Accidental Injury — definite trauma resulting from a sud- den, unexpected and unplanned event, occurring by chance, caused by an independent external source. Activities of Daily Living (ADL) — mobility skills required for independence in normal everyday living. Recreational, leisure, or sports activities are not included. Acute Care — care rendered in the course of treating an ill- ness, injury or condition marked by a sudden onset or change of status requiring prompt attention, which may include hos- pitalization, but which is of limited duration and which is not expected to last indefinitely. Agreement — this contract, the appendices, all endorsements to it, and all applications for coverage and health statements. Allowable Amount — the Blue Shield of California Allow- ance (as defined below) for the Service (or Services) ren- dered, or the provider's billed charge, whichever is less. The Blue Shield of California Allowance, unless otherwise speci- fied for a particular Service elsewhere in this Agreement, is:.