Common use of SERVICES RENDERED TO INELIGIBLE SUBSCRIBERS Clause in Contracts

SERVICES RENDERED TO INELIGIBLE SUBSCRIBERS. PacifiCare agrees to reimburse IPA for those Medical Services set forth in Attachment A2 provided to an ineligible Subscriber if the Subscriber was listed as eligible on the most current eligibility list provided to IPA by PacifiCare. If PacifiCare is in receipt of a billing to such ineligible Subscriber from IPA and proof of having sent the Subscriber or the Subscriber's legal guardian two (2) bills no less than thirty (30) days apart, PacifiCare will reimburse IPA [ ** ] of IPA's ordinary and customary fee-for-service rates then in effect for those Medical Services rendered but no greater than [ ** ] of the still uncollected balance. If subsequent to payment by PacifiCare, IPA receives any payment from another source for the services, then IPA shall reimburse PacifiCare up to the amount previously received from PacifiCare. If a Subscriber becomes ineligible for benefits under the Secure Horizons Medical and Hospital Plan after IPA or Member Physicians have begun treatment of the Subscriber (provided the Subscriber is not hospitalized at the time of becoming ineligible), IPA shall be entitled to make all subsequent charges for its services directly to the Subscriber. If the Subscriber is hospitalized at the time of becoming ineligible, IPA shall be entitled to make charges directly to the Subscriber for future medical services, only for services provided after the Subscriber is discharged from such hospital treatment.

SERVICES RENDERED TO INELIGIBLE SUBSCRIBERS. PacifiCare agrees to reimburse IPA for those Medical Services set forth in Attachment A2 which were provided to an ineligible Subscriber if the Subscriber was listed as eligible on the most current eligibility list Eligibility List provided to IPA by PacifiCare. If if PacifiCare is in receipt of a billing to such ineligible Subscriber from IPA and proof of having sent the Subscriber or the Subscriber's legal guardian two (2) bills no less than thirty (30) days apart, PacifiCare will reimburse IPA [ ** ] eighty percent (80k) of IPA's ordinary and customary fee-for-service rates then in effect for those Medical Services rendered but no greater than [ ** ] one hundred percent (look) of the still uncollected balance. If subsequent to payment by PacifiCare, IPA receives any payment from another source for the services, then IPA shall reimburse PacifiCare up to the amount previously received from PacifiCare. If a Subscriber becomes ineligible for benefits under the Secure Horizons Medical and Hospital PacifiCare Health Plan after IPA or Member Physicians have begun treatment of the Subscriber (provided the Subscriber is not hospitalized at the time of becoming ineligible), IPA shall be entitled to make all subsequent charges for its services directly to the Subscriber. If the Subscriber is hospitalized at the time of becoming ineligible, IPA shall be entitled to make charges directly to the Subscriber for future medical services, only for services provided after the Subscriber is discharged from such hospital treatment.

SERVICES RENDERED TO INELIGIBLE SUBSCRIBERS. PacifiCare agrees to reimburse IPA for those Medical Services set forth in Attachment A2 provided to an ineligible Subscriber if the Subscriber was listed as eligible on the most current eligibility list provided to IPA by PacifiCare. If PacifiCare is in receipt of a billing to such ineligible Subscriber from IPA and proof of having sent the Subscriber or the Subscriber's legal guardian two (2) bills no less than thirty (30) days apart, PacifiCare will reimburse IPA [ ** ] eighty percent (80%) of IPA's ordinary and customary fee-for-service rates then in effect for those Medical Services rendered but no greater than [ ** ] one hundred percent (100%) of the still uncollected balance. If subsequent to payment by PacifiCare, IPA receives any payment from another source for the services, then IPA shall reimburse PacifiCare up to the amount previously received from PacifiCare. If a Subscriber becomes ineligible for benefits under the Secure Horizons Medical and Hospital Plan after IPA or Member Physicians have begun treatment of the Subscriber (provided the Subscriber is not hospitalized at the time of becoming ineligible), IPA shall be entitled to make all subsequent charges for its services directly to the Subscriber. If the Subscriber is hospitalized at the time of becoming ineligible, IPA shall be entitled to make charges directly to the Subscriber for future medical services, only for services provided after the Subscriber is discharged from such hospital treatment.