Out-of-Network Providers definition

Out-of-Network Providers means those entities and individuals who provide covered health care services or supplies who are not network providers.
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Out-of-Network Providers means providers not on the Affinity Health Network or, providers that have no business relationship with Affinity Health. Costs incurred for most out-of-network providers are not reimbursed unless specifically Pre-authorised per event.
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Out-of-Network Providers means providers who are not a part of the UK HealthCare (Preferred Providers) and are not included in the list of In-network Providers. Out-of-network Providers have no contractual relationship with the Student Health Plan. If an Out-of-network provider charges an amount in excess of the Usual and Customary charge for a service, the covered individual will be responsible for the excess amount and the excess amount will not be counted toward satisfying the Covered Individual’s Out-of-pocket Limit.
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Examples of Out-of-Network Providers in a sentence

  • Out-of-Network Providers Out-of-network providers are providers that are not part of your network.

  • Out-of-Area Services and Out-of-Network Providers Outside Oscar’s Service Area Outside of Our Service area, Oscar covers only Emergency or Urgent Care services.

  • Out-of-Network Providers do not have a contract with Us and You will be responsible for the total amount billed by an Out-of-Network Provider for services that are denied because they are not Medically Necessary.

  • Pay for Covered Health Care Services Provided by Out-of-Network Providers In accordance with any state prompt pay requirements, we pay Benefits after we receive your request for payment that includes all required information.

  • The CHC-MCO must limit the amount paid to Out-of-Network Providers of Emergency Services to no more than the amount that would have been paid for such services under the Department’s FFS Program.

  • In-Network Benefits for Out-of-Network Providers The following covered services and supplies provided by out-of-network providers will always be covered at the in-network level of benefits (based on the out-of-network allowed amount):  Emergency care for a medical emergency.

  • Services from Out-of-Network Providers This plan provides benefits for non-emergency services from out-of-network providers at a lower benefit level.

  • Specifically, you may be required to pay higher cost sharing amounts or may have limits on your benefits when using Out-of-Network Providers.

  • Out-of-Network Providers The amount we pay for dialysis will be no less than a comparable provider that has a contracting agreement with us and no more than 90% of billed charges.

  • Services from Out-of-Network Providers Generally out-of-network providers are not covered on your plan, except for emergency services.


More Definitions of Out-of-Network Providers

Out-of-Network Providers are providers that do not participate in the Blue Network. BlueCross’s payment for Covered Services to any Out-of-Network Provider will be based on Maximum Allowable Charge for the service performed. Except as required by applicable law, (including the No Surprises Act enacted as part of the Consolidated Appropriations Act , 2021 as described later in this Exhibit C), upon receipt of a completed claim form, and provided adequate funding from Employer is available, BlueCross shall make payment for Covered Services to the DocuSign Envelope ID: CD93B45A-0105-43E7-9602-5AE5EB65AF29 DocuSign Envelope ID: 00C2B362-1FE5-4A7F-86FB-24039505711D Out-of-Network Provider and not the Member, unless BlueCross receives proof of payment from the Member before payment is made to the provider. Except as required by applicable law, when the Member receives services from an Out-of- Network Provider, he or she will be responsible for the payment of any difference between BlueCross’s payment and such provider’s charge(s), and responsible for any applicable Deductible, Copayment, and Coinsurance, as well as payment of charges for any non-covered services. The Member’s responsibility for Coinsurance will be based on the Maximum Allowable Charge for that service. Maximum Allowable Charge shall be calculated as determined by BlueCross in accordance with the EOC, BlueCross policies and applicable law.
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Out-of-Network Providers means Providers who do not meet the definition of Network Providers.
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Out-of-Network Providers means that for one reason or another, they are a non-preferred healthcare provider for your insurance company. This can often mean they have higher
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Out-of-Network Providers means those entities and individuals who provide covered health care services and supplies who are not network providers.
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Related to Out-of-Network Providers

  • Out-of-network provider means any provider that is not directly or indirectly employed by or does not have a provider agreement with the contractor or any of its subcontractors pursuant to the contract between the department and the contractor.

  • Out-of-network means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.

  • Non-Network Provider means any hospital, day care centre or other provider that is not part of the network.

  • Network Provider means a provider of health care, or a group of providers of health care, which has entered into a written agreement with the issuer to provide benefits insured under a Medicare Select policy.

  • Internet Service Provider (ISP) is an Enhanced Service Provider that provides Internet Services, and is defined in paragraph 341 of the FCC’s First Report and Order in CC Docket No. 97-158.

  • ACS means “asset-controlling supplier” as that term is defined in the Cap and Trade Regulations.

  • Database Management System (DBMS) A system of manual procedures and computer programs used to create, store and update the data required to provide Selective Routing and/or Automatic Location Identification for 911 systems. Day: A calendar day unless otherwise specified. Dedicated Transport: UNE transmission path between one of CenturyLink’s Wire Centers or switches and another of CenturyLink’s Wire Centers or switches within the same LATA and State that are dedicated to a particular customer or carrier. Default: A Party’s violation of any material term or condition of the Agreement, or refusal or failure in any material respect to properly perform its obligations under this Agreement, including the failure to make any undisputed payment when due. A Party shall also be deemed in Default upon such Party’s insolvency or the initiation of bankruptcy or receivership proceedings by or against the Party or the failure to obtain or maintain any certification(s) or authorization(s) from the Commission which are necessary or appropriate for a Party to exchange traffic or order any service, facility or arrangement under this Agreement, or notice from the Party that it has ceased doing business in this State or receipt of publicly available information that signifies the Party is no longer doing business in this State.

  • Outsource means to cause a Service to be provided by a third-party provider which is not an Affiliate of the Provider.

  • Internet Service Provider (ISP) means an Enhanced Service Provider (ESP) that provides Internet Services.

  • Contractor Project Manager means the employee identified in a Statement of Work as the Contractor project manager.

  • The Service Provider means the Bidder or firm supplying the Services under this Contract.

  • Third Party Service Providers means any third party wherever situated selected by us or any member of the BEA Group to provide services to it.

  • Platform Services means the products and services that Platform Users receive from a Stripe Connect Platform, regardless of whether fees are charged (e.g., web development, customer support or hosting services).

  • Video service provider or "provider" means a person authorized under this act to provide video service.

  • energy service provider means a natural or legal person who delivers energy services or other energy efficiency improvement measures in a final customer’s facility or premises;

  • Service Provider Personnel means and refers to Service Provider employees or subcontractors hired and maintained to perform Services hereunder.

  • BT Network means the communications network owned or leased by BT and used to provide a Service.

  • Database Management System (“DBMS”) is a computer process used to store, sort, manipulate and update the data required to provide Selective Routing and ALI.

  • Maintenance and Support Services means the services provided by Contractor under Appendix F.

  • FIS means free into store delivery, which requires the Supplier to pay all costs and be responsible for all requirements associated with the supply and delivery of Goods to the Company at the delivery site described in the Order, including all costs associated with transport, insurances, licences, authorisations, duties and taxes.

  • T&Cs means these terms and conditions.

  • Customer Portal means a web portal maintained by Liferay or a Liferay Affiliate that provides for various resources accessible to Liferay Subscription customers as further described in Section 2.1 below.

  • Medically Necessary Services means those covered services that are, under the terms and conditions of the contract, determined through contractor utilization management to be:

  • Support Services means support in relation to the use of, and the identification and resolution of errors in, the Hosted Services, but shall not include the provision of training services;

  • Wireless infrastructure provider means any person, including a person authorized to provide telecommunications service in the state, that builds or installs transmission equipment, wireless facilities, or wireless support structures, but that is not a wireless services provider.