Your Claims Checklist Sample Clauses

Your Claims Checklist. Before you try to submit a claim for costs incurred, please use the checklist below to verify that you have all of the required information and documentation: - CHECKLIST I have paid for treatment and I would like to claim back all costs I have not yet received treatment. I would like Alliance Health to contact the provider of medical services and request the acceptance of a Guarantee of Payment so that I do not have to pay and claim* I have checked that the treatment was not for an ineligible condition or an excluded condition I have checked that this service can be pre-authorised and that the provider of medical services is willing to accept a Guarantee of Payment I have checked the benefits of my plan level and I should be covered for this treatment I have checked that the treatment was not for an ineligible condition or an excluded condition I have checked that the date of treatment was in the last 3 months I have checked the benefits of my plan level and I should be covered for this treatment I have a completed Claim Form, with every section complete, with both the doctor’s and the main member’s signatures I have provided Alliance Health with a Medical Report from my doctor I have a receipt for every one of the payments I made I have provided Alliance Health with the names and contact details of the providers of the treatment I have a Claim Form ready for completion I have provided Alliance Health with quotations of costs and the dates of the proposed treatment *Pre-authorisation and guarantees of payment can ONLY be placed for advanced imagery (MRI, CT, PET and Ultrasound Scans), diagnostics for surgery, for all treatment relating to cancer, for all hospitalisation and for consultations with specialists. Pre-authorisation is not required for family doctor consultations, medication or for casualty consultations for life threatening medical emergencies.
Sample 1
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Related to Your Claims Checklist

  • Administrative Claims Requirements and Procedures No suit or arbitration shall be brought arising out of this Agreement against City unless a claim has first been presented in writing and filed with City and acted upon by City in accordance with the procedures set forth in Chapter 1.34 of the Chula Vista Municipal Code, as same may be amended, the provisions of which, including such policies and procedures used by City in the implementation of same, are incorporated herein by this reference. Upon request by City, Consultant shall meet and confer in good faith with City for the purpose of resolving any dispute over the terms of this Agreement.

  • Claims Covered and Released 4.1 Xxxxxxx’x Release of Proposition 65 Claims Xxxxxxx acting on his own behalf, and not on behalf of the public, releases Eccolo, its parents, subsidiaries, affiliated entities under common ownership, directors, officers, agents employees, attorneys, and each entity to whom Eccolo directly or indirectly distributes or sells the Products, including, but not limited, to downstream distributors, wholesalers, customers, retailers including, but not limited to The TJX Companies, Inc., franchisees, cooperative members, importers, and licensees (collectively, “Releasees”), from all claims for violations of Proposition 65 through the Effective Date based on unwarned exposures to lead in the Products. The Parties understand and agree that this Section 4.1 release shall not extend upstream to any entities that manufactured the Products or any component parts thereof, or any distributors or suppliers who sold the Products or any component parts thereof to Eccolo.

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