Common use of Member Liability Calculation Clause in Contracts

Member Liability Calculation. When covered healthcare services are provided outside of CareFirst service area by nonparticipating providers, the amount you pay for such services will normally be based on either the Host Blue’s nonparticipating provider local payment or the pricing arrangements required by applicable state law. In these situations, you may be responsible for the difference between the amount that the nonparticipating provider bills and the payment CareFirst will make for the covered healthcare services as set forth in this paragraph. Federal or state law, as applicable, will govern payments for out-of-network emergency services.

Member Liability Calculation. When covered healthcare services are provided outside of CareFirst service area by nonparticipating non-participating providers, the amount you pay for such services will normally be based on either the Host Blue’s nonparticipating non-participating provider local payment or the pricing arrangements required by applicable state law. In these situations, you may be responsible for the difference between the amount that the nonparticipating non-participating provider bills and the payment CareFirst will make for the covered healthcare services as set forth in this paragraph. Federal or state law, as applicable, will govern payments for out-of-network emergency services.