Procedures for Health Services Received from Non-Participating Providers. If [You receive][an Enrollee receives] Health Services from a Non-Participating Provider, the rules below apply for claims submitted by You or by a Non-Participating Provider on Your behalf. Claim Forms. You can locate Our claim forms on Our website, xxx.xxxxxxxxxxxxxxxxx.xxx, or You can notify us of a claim and We will mail You Our claim forms. If You do not receive Our usual claim forms within fifteen (15) days of this request, You may file a claim without them. The claims must contain written Claim Documentation.
Appears in 4 contracts
Samples: www.mdwise.org, www.mdwise.org, www.mdwise.org