Non-Participating Provider means an Administrator Hospital or Professional Provider which does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to participants in the Participating Provider Option program or a facility which has not been designated by the Claim Administrator as a Participating Provider.
Non-Participating Provider means a Plan Hospital or Professional Pro vider which does not have a written agreement with Blue Cross and Blue Shield of Illinois or another Blue Cross and/or Blue Shield Plan to provide services to participants in a Participating Provider Option program or a fa cility which has not been designated by Blue Cross and Blue Shield of Illinois as a Participating Provider.
Non-Participating Provider means an Administrator Hospital or Pro fessional Provider which does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide ser vices to participants in the Participating Provider Option program or a facility which has not been designated by the Claim Administrator as a Par ticipating Provider.
Examples of Non-Participating Provider in a sentence
Reimbursements for services rendered by a Non-Participating Provider will be based on Our Allowable Charge and will be paid under the same limits, rules and policies that We would have applied to claims for services rendered by a Participating Provider.
In certain situations, and only when permitted by the Claims Administrator, a Member may consent to allow a Non-Participating Provider to be reimbursed directly.
You should know that care received from a Non-Participating Provider could mean a higher cost to you.
We recommend that you ask the Non-Participating Provider about their billed charges before you receive care.
If the Member receives Emergency Services from a Non-Participating Provider or Non-Participating Emergency Facility, the most the Non-Participating Provider or Non-Participating Emergency Facility may bill the Member is the In-Network cost-share.
More Definitions of Non-Participating Provider
Non-Participating Provider means, for purposes of this Amendment only, with respect to a covered item or service, a physician or other health care provider who does not have a contractual relationship with BCBSMT for furnishing such item or service under the Contract to which this Amendment is attached.
Non-Participating Provider means, for purposes of this section only, with respect to a covered item or service, a Physician or other health care provider who does not have a contractual relationship with BCBSMT for furnishing such item or service under The Plan.
Non-Participating Provider means a provider that does not have a contractual relationship with an MCE and is not on their panel of providers.
Non-Participating Provider means a provider of medical care and/or services with which the Contractor has no Provider Agreement.
Non-Participating Provider means a Hospital or Professional Provider that either: (i) does not have a written agreement with Blue Cross and Blue Shield of Illinois or another Blue Cross and/or Blue Shield to provide services to participants in the benefit program, or; (ii) has not been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider in the benefit program.
Non-Participating Provider. A Provider who doesn’t have a contract with Us to provide health care services to You. You will pay more to see a Non-Participating Provider. Out-of-Network Coinsurance: Your share of the costs of a Covered Service calculated as a percent of the Allowed Amount for the service that You are required to pay to a Non-Participating Provider. The amount can vary by the type of Covered Service. Out-of-Network Copayment: A fixed amount You pay directly to a Non-Participating Provider for a Covered Service when You receive the service. The amount can vary by the type of Covered Service. Out-of-Network Deductible: The amount You owe before We begin to pay for Covered Services received from Non-Participating Providers. The Out-of-Network Deductible applies before any Copayments or Coinsurance are applied. The Out-of-Network Deductible may not apply to all Covered Services. You may also have an Out-of-Network Deductible that applies to a specific Covered Service (e.g., a Prescription Drug Deductible) that You owe before We begin to pay for a particular Covered Service. Out-of-Pocket Limit: The most You pay during a Plan Year in Cost-Sharing before We begin to pay 100% of the Allowed Amount for Covered Services. This limit never includes Your Premium, Balance Billing charges or the cost of dental care services We do not Cover. The Out-of-Pocket Limit only applies to benefits that are part of the pediatric dental essential health benefit.
Non-Participating Provider means a provider of medical care and/or services with which the Contractor has no Provider Agreement, as this term is defined in this Agreement.