Pre-Service Claim definition

Pre-Service Claim means a claim for a medical care benefit with respect to which the plan conditions receipt of the benefit, in whole or in part, on approval of the benefit in advance of receipt of care.

Pre-Service Claim means any Claim for Benefits under a Health Benefit Plan with respect to which the terms of the Plan condition receipt of the benefit, in whole or in part, on approval of the benefit in advance of obtaining medical care.

Pre-Service Claim means any claim for a benefit with respect to which the terms of the Plan condition receipt of the benefit, in whole or in part, on approval of the benefit in advance of obtaining medical care.

Examples of Pre-Service Claim in a sentence

• An appeal of an Adverse Benefit Determination with respect to a Post-Service Claim may be submitted to AvMed’s Member Engagement Center, at the address listed in Appeal of a Pre-Service Claim, above.

• AvMed will notify the Claimant of the benefit determination with respect to a Pre-Service Claim no later than 15 days after receipt of the Claim.

• An appeal of an Adverse Benefit Determination with respect to an Urgent Care Claim may be submitted to AvMed’s Member Engagement Center at the address listed under Appeal of a Pre-Service Claim, above.

• A Claimant may appeal an Adverse Benefit Determination with respect to a Pre-Service Claim within 365 days of receiving the Adverse Benefit Determination.

• A Pre-Service Claim is any claim for a medical benefit which the Plan terms condition the Covered Person’s receipt of the benefit, in whole or in part, on approval of the benefit before obtaining treatment.

More Definitions of Pre-Service Claim

Pre-Service Claim means any Claim for a benefit under this Plan where the Plan conditions receipt of the benefit, in whole or in part, on approval in advance of obtaining Medical Care. These are, for example, Claims subject to Preauthorization.

Pre-Service Claim means the request for a plan benefit(s) by a claimant prior to a

Pre-Service Claim means a claim for a benefit under a group health plan that, under the terms of the applicable plan, conditions the receipt of the benefit, in whole or in part, on pre-approval of the benefit in advance of obtaining medical care.

Pre-Service Claim means any Claim for a benefit under a Health Benefit Program which conditions receipt of the benefit, in whole or in part, on approval in advance of obtaining medical care.

Pre-Service Claim means a request for approval of a prescription drug benefit where receipt of the benefit is conditioned, in whole or in part, on approval in advance of obtaining the prescription drug. Examples include pre-authorizations of certain prescription drugs.

Pre-Service Claim means any claim in which receipt of the benefit is conditioned, in whole or in part, upon precertification or preauthorization by the Plan.

Pre-Service Claim means any Claim or authorization or determination of Benefits under a LIBERTY Dental Plan in advance of obtaining the requested services.