You Pay You Pay Clause Samples
The "You Pay You Pay" clause establishes the obligation of one party to make payments as specified in the agreement, regardless of any disputes or issues that may arise. In practice, this means that the paying party must fulfill their payment responsibilities on time, even if they believe there is a problem with the goods or services provided, or if there are unresolved disagreements. This clause ensures that the recipient of payment receives funds without delay, thereby reducing the risk of non-payment and maintaining cash flow while any disputes are resolved separately.
You Pay You Pay. Acupuncture Services
You Pay You Pay. Pregnancy and Maternity Services Prescription Drugs and Diabetic Equipment and Supplies
You Pay You Pay. In a physician’s/dentist’s office - When services are due to accidental injury to sound natural teeth. 10% - After deductible Not Covered Services connected to dental care when performed in an outpatient facility * 10% - After deductible Not Covered Oral evaluations 0% Not Covered X-rays 0% Not Covered Cleanings (prophylaxis) 0% Not Covered Fluoride treatments 0% Not Covered Sealants 0% Not Covered Space Maintainers 0% Not Covered Palliative treatment 50% - After deductible Not Covered Fillings 50% - After deductible Not Covered Simple extractions 50% - After deductible Not Covered Denture repairs and relines/rebasing 50% - After deductible Not Covered Crowns & onlays 50% - After deductible Not Covered Therapeutic Pulpotomies 50% - After deductible Not Covered Root canal therapy 50% - After deductible Not Covered Non-surgical periodontal services 50% - After deductible Not Covered Surgical periodontal services 50% - After deductible Not Covered Periodontal maintenance 50% - After deductible Not Covered Fixed bridges and dentures 50% - After deductible Not Covered Implants 50% - After deductible Not Covered Oral surgery services 50% - After deductible Not Covered General anesthesia or IV sedation - dental office 50% - After deductible Not Covered Biopsies 50% - After deductible Not Covered Occlusal (night) guards 50% - After deductible Not Covered Orthodontic services (braces) - when medically necessary. 50% - After deductible Not Covered Inpatient/outpatient/in your home 10% - After deductible Not Covered Durable Medical Equipment (DME), Medical Supplies, Diabetic Supplies, Prosthetic Devices, and Enteral Formula or Food, Hair Prosthetics Outpatient durable medical equipment* - Must be provided by a licensed medical supply provider. 10% - After deductible Not Covered Outpatient medical supplies* - Must be provided by a licensed medical supply provider. 10% - After deductible Not Covered Outpatient diabetic supplies/equipment purchased at licensed medical supply provider (other than a pharmacy). See the Summary of Pharmacy Benefits for supplies purchased at a pharmacy. 10% - After deductible Not Covered Outpatient prosthesis* - Must be provided by a licensed medical supply provider. 10% - After deductible Not Covered Enteral formula delivered through a feeding tube. Must be sole source of nutrition. 10% - After deductible Not Covered Enteral formula or food taken orally * 10% - After deductible The level of coverage is the same as network provider. Covered ...
You Pay You Pay. Outpatient hospital (after the first 30 days) or in a doctor’s/therapist’s office. Limited to thirty (30) physical therapy visits and 30 occupational therapy visits per member per plan year. 20% - After deductible 20% - After deductible
You Pay You Pay. In a physician’s/dentist’s office - When services are due to accidental injury to sound natural teeth. $25 - After deductible Not Covered Services connected to dental care when performed in an outpatient facility * 0% - After deductible Not Covered Inpatient/outpatient/in your home 0% - After deductible Not Covered