Out-of-network services definition

Out-of-network services means services rendered to a covered person by a health care provider
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Out-of-network services means health services that are provided to a recipient of services which are not subject to payment at a negotiated rate under an agreement between the provider and a public or private third-party payer or insurer for the recipient of services.
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Out-of-network services means those services rendered to BLUE CROSS PLUS Members by a Non-Participating Provider, and which would be Capitation Services if rendered by PARTICIPATING MEDICAL GROUP under the Agreement to CALIFORNIACARE Members, except for Out-of-Area Emergency Services.
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Examples of Out-of-network services in a sentence

  • If any of Medical Group’s Participating Providers provides Out-of-Network Services to a Commercial POS Plan Member, such Medical Group Participating Provider shall xxxx PacifiCare or the payor responsible for payment for Out-of-Network Services for such services and agrees to accept full payment at the Cost of Care.

  • The Professional Stop Loss Program includes coverage for In-Network Services, an optional program, as well as for Out-of-Network Services, a program in which PPG’s participation is required.

  • The Commercial POS Control Program is designed to provide an incentive for the efficient and effective use of In-Network Hospital Services and to control Out-of-Network Services, and shall be calculated in accordance with the following provisions.

  • Blue Shield is solely entitled to collect and retain any and all third party liens, coordination of benefits, or any other payments obtained from third party payments for Out-of-Network Services provided to BSC POS Members by non-Group Providers.

  • In the event that a BSC POS Member elects to obtain Out-of-Network Services, Group shall cooperate with the provider of such Out-of-Network Services to ensure coordination and continuity of care and, upon request of such provider of Out-of-Network Services (and with the BSC POS Member’s written authorization), provide copies of the BSC POS Member’s relevant medical records to such provider.

  • Costs for In-Network Hospital Services and Out-of-Network Services that exceed the Commercial POS Control Program Reinsurance Deductible shall be considered an expense against the Commercial POS Plan Budget, of which surpluses and deficits are shared equally between PacifiCare and the Commercial POS Plan Budget.

  • Costs for In-Network Hospital Services and Out-of-Network Services that exceed the Commercial POS Control Program Reinsurance Deductible shall be considered an expense against the Commercial POS Plan Budget, of which surpluses and deficits are shared between PacifiCare and Medical Group as noted below.

  • PPG Capitated Services and Shared Risk Services provided or arranged through PPG.2.2 Out-of-Network Services.

  • PacifiCare and IPA desire to establish a Secure Horizons Point-Of-Service Control Program for the purpose of providing a financial incentive for the control of Out-of-Network Services.

  • The Commercial POS Control Program is designed to provide an incentive to control Out-of-Network Services, and shall be calculated in accordance with the following provisions.


More Definitions of Out-of-network services

Out-of-network services means health care items or services that are covered services under a PSO's Medicare contract and that are provided to beneficiaries by health care providers that are not participating providers in the PSO's network of health care providers.
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Out-of-network services to incentivize in network usage, reimbursement rates are reduced for out of network labs, and other out of network services. Be careful to check if your providers and labs are out of network. • Out of Network reimbursement rate for mental and behavioral health will increase after reaching the out of pocket maximum for the plan year. Out of network obstetrical treatment received as of 7/1/2019 will be covered at a higher rate until that treatment is completed.
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Out-of-network services means health care items or services that are
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Out-of-network services means a clinician's professional
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Out-of-network services means services provided to subscribers by an Out-of- Network Provider.
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Related to Out-of-network services

  • 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.

  • 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;

  • Online Services means Microsoft-hosted services to which Customer subscribes under this Agreement. It does not include software and services provided under separate license terms.

  • Hosting Services means the provision, administration, and maintenance of servers and related equipment, the provision of bandwidth at the hosting facility, and the operation of the Application for access by Customer Users to be provided by the relevant hosting service provider.

  • Design Services means architect services, engineer services or landscape architect services.

  • Cloud Services means SAP’s then-current cloud services offered under and described in detail in the applicable SAP PartnerEdge Model.