Common use of How Non-network Providers Are Paid Clause in Contracts

How Non-network Providers Are Paid. Except in the special circumstances described below, if you receive care from a non- network provider, you are responsible for paying all charges for the services you received. You may submit a claim for reimbursement of the payments you made. We reimburse non-network provider services using the same guidelines we use to pay network providers. Generally, our payment for non-network provider services will not be more than the amount we pay for network provider services. If an allowance for a specific covered healthcare service cannot be determined by reference to a fee schedule, reimbursement will be based upon a calculation that reasonably represents the amount paid to network providers. When covered healthcare services are received from a non-network provider, we reimburse you or the non-network provider, less any copayments and deductibles, based on: • the lesser of: • our allowance; • the non-network provider’s charge; or • the benefit limit; or • federal or state law, when applicable. You are responsible for the deductible, if one applies, and the copayment, as well as any amount over the benefit limit that applies to the service you received. You are responsible for the difference between the amount that the non-network provider bills and the payment we make. Generally, we send reimbursement to you, but we reserve the right to reimburse a non-network provider directly. Payments we make to you are personal. You cannot transfer or assign any of your right to receive payments under this agreement to another person or organization, unless the R.I. General Law §27-20-49 (Dental Insurance assignment of benefits) applies.

How Non-network Providers Are Paid. Except in the special circumstances described below, if If you receive care from a non- non-network provider, you are responsible for paying all charges for the services you received. You may submit a claim for reimbursement of the payments you made. We reimburse non-network provider services using the same guidelines we use to pay network providers. Generally, our payment for non-network provider services will not be more than the amount we pay for network provider services. If an allowance for a specific covered healthcare service cannot be determined by reference to a fee schedule, reimbursement will be based upon a calculation that reasonably represents the amount paid to network providers. When covered healthcare services are received from a non-network provider, we reimburse you or the non-network provider, less any copayments and deductibles, based on: • the lesser of: • our allowance; • the non-network provider’s charge; or • the benefit limit; or • federal or state law, when applicable. You are responsible for the deductible, if one applies, and the copayment, as well as any amount over the benefit limit that applies to the service you received. You are responsible for the difference between the amount that the non-network provider bills and the payment we make. Generally, we send reimbursement to you, but we reserve the right to reimburse a non-network provider directly. Payments we make to you are personal. You cannot transfer or assign any of your right to receive payments under this agreement to another person or organization, unless the R.I. General Law §27-20-49 (Dental Insurance assignment of benefits) applies.

How Non-network Providers Are Paid. Except in the special circumstances described below, if ‌ If you receive care from a non- non-network provider, you are responsible for paying all charges for the services you received. You may submit a claim for reimbursement of the payments you made. We reimburse non-network provider services using the same guidelines we use to pay network providers. Generally, our payment for non-network provider services will not be more than the amount we pay for network provider services. If an allowance for a specific covered healthcare service cannot be determined by reference to a fee schedule, reimbursement will be based upon a calculation that reasonably represents the amount paid to network providers. When covered healthcare services are received from a non-network provider, we reimburse you or the non-network provider, less any copayments and deductibles, based on: • the lesser of: • our allowance; • the non-network provider’s charge; or • the benefit limit; or • federal or state law, when applicable. You are responsible for the deductible, if one applies, and the copayment, as well as any amount over the benefit limit that applies to the service you received. You are responsible for the difference between the amount that the non-network provider bills and the payment we make. Generally, we send reimbursement to you, but we reserve the right to reimburse a non-network provider directly. Payments we make to you are personal. You cannot transfer or assign any of your right to receive payments under this agreement to another person or organization, unless the R.I. General Law §27-20-49 (Dental Insurance assignment of benefits) applies.

How Non-network Providers Are Paid. Except in the special circumstances described below, if you receive care from a non- network provider, you are responsible for paying all charges for the services you received. You may submit a claim for reimbursement of the payments you made. We reimburse non-network provider services using the same guidelines we use to pay network providers. Generally, our payment for non-network provider services will not be more than the amount we pay for network provider services. If an allowance for a specific covered healthcare service cannot be determined by reference to a fee schedule, reimbursement will be based upon a calculation that reasonably represents the amount paid to network providers. When covered healthcare services are received from a non-network provider, we reimburse you or the non-network provider, less any copayments and deductibles, based on: • the lesser of: • our allowance; • the non-network provider’s charge; or • the benefit limit; or • federal or state law, when applicable. You are responsible for the deductible, if one applies, and the copayment, as well as any amount over the benefit limit that applies to the service you received. You are responsible for the difference between the amount that the non-network provider bills and the payment we make. Generally, we send reimbursement to you, but we reserve the right to reimburse a non-network provider directly. Payments we make to you are personal. You cannot transfer or assign any of your right to receive payments under this agreement to another person or organization, organization unless the R.I. General Law §27-20-49 (Dental Insurance assignment of benefits) applies.