PremierBlue Shield Professional Provider and Preferred Supplier Sample Clauses

PremierBlue Shield Professional Provider and Preferred Supplier. (Out-of- Area): The Plan’s coinsurance liability arises after the member’s deductible obligation is subtracted from the Provider’s Reasonable Charge. At that time, the Plan will pay ninety percent (90%) of the remaining amount and the member’s coinsurance obligation will be ten percent (10%) of the remaining amount. The member is obligated to pay the coinsurance amount as well as any deductible amounts. The PremierBlue Shield professional provider or preferred supplier will accept the Plan’s payment plus the member’s coinsurance and/or deductible as payment in full for covered services rendered to the member. The PremierBlue Shield professional provider is not obligated to accept such payment as payment in full if the member fails to remit the coinsurance and/or deductible amounts to the PremierBlue Shield professional provider in a timely manner. The member shall remit or make arrangements to pay any coinsurance and/or deductible amounts directly to the PremierBlue Shield professional provider within sixty (60) days of the Plan’s finalization of the claim. Otherwise, the member will also be responsible for the difference between the PremierBlue Shield professional provider’s billed charge and the Plan’s payment.
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