Common use of Provider/Supplier Reimbursement and Member Liability Clause in Contracts

Provider/Supplier Reimbursement and Member Liability. The Provider’s Reasonable Charge is the allowance or payment that the Plan has determined is reasonable for covered services provided to a member based upon the provider who renders such services. Specifically, it is the portion of the provider’s billed charge that will be recognized by the Plan and used to calculate the benefit payable and the financial liability of the member under this Agreement. In the event that a provider has not agreed to accept the provider’s Reasonable Charge as payment in full, any amounts billed by the provider in excess of the Provider’s Reasonable Charge are not covered under this Agreement and shall be the financial responsibility of the member. Deductible and coinsurance amounts shall be applied to the Provider’s Reasonable Charge to determine the benefit amount payable by the Plan.

Provider/Supplier Reimbursement and Member Liability. The Provider’s Reasonable Charge is the allowance or payment that the Plan has determined is reasonable for covered services Covered Services provided to a member based upon the provider who renders such services. Specifically, it is the portion of the provider’s billed charge that will be recognized by the Plan and used to calculate the benefit payable and the financial liability of the member under this Agreement. In the event that a provider has not agreed to accept the providerProvider’s Reasonable Charge as payment in full, any amounts billed by the provider in excess of the Provider’s Reasonable Charge are not covered under this Agreement and shall be the financial responsibility of the member. Deductible and coinsurance Coinsurance amounts shall be applied to the Provider’s Reasonable Charge to determine the benefit amount payable by the Plan. See Section 10.