RIGHT TO RECOVER PAYMENTS MADE IN ERROR Clause Samples

The "Right to Recover Payments Made in Error" clause gives a party the legal ability to reclaim any funds that were mistakenly paid to the other party under the agreement. In practice, this means if an overpayment or duplicate payment occurs due to administrative mistakes or miscalculations, the paying party can request reimbursement or offset the amount against future payments. This clause ensures that financial errors can be corrected efficiently, preventing unjust enrichment and maintaining fairness in the contractual relationship.
RIGHT TO RECOVER PAYMENTS MADE IN ERROR. If the HMO should pay for any contractually excluded services through inadvertence or error, the HMO maintains the right to seek recovery of such payment from the Provider or Member to whom such payment was made. "Emergency Services" are any health care services provided to a Member after the sudden onset of a medical condition. The condition manifests itself by acute symptoms of sufficient severity or severe pain, such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in:  placing the health of the Member or with respect to a pregnant Member, the health of the Member or her unborn child, in serious jeopardy;  serious impairment to bodily functions; or  serious dysfunction of any bodily organ or part.  Other serious medical consequences Emergency transportation and related Emergency Service provided by a licensed ambulance service shall constitute an Emergency Service. In a true emergency, the first concern is to obtain necessary medical treatment; so Members should seek care from the nearest appropriate Facility Provider. Emergency Services do not require a Referral for treatment from the Primary Care Physician. Emergency Services are covered whether they are provided inside or outside Keystone’s Limited Network Area. Emergency Services do not require a Referral for treatment from the Member’s Primary Care Physician. A Member must notify their Primary Care Physician to coordinate all continuing care. Medically Necessary Care by any provider other than the Member’s Primary Care Physician will be covered until the Member can, without medically harmful consequences, be transferred to the care of their Primary Care Physician, a Referred Specialist designated by their Primary Care Physician, an Obstetrician or Gynecologist, or a Dialysis Specialist. When Emergency Services are provided by Non-Participating Providers, Benefits will be provided at the in- network benefit level. Members will be responsible for any applicable Cost-Sharing Amounts such as Deductibles, Coinsurance, and Copayments. In situations where emergency services cannot reasonably be attended to by a preferred provider, the Member is not liable for a greater out-of-pocket expense than if they had been attended to by a preferred provider. Examples of conditions requiring Emergency Services are: excessive bleeding; broken bones; serious ▇▇▇▇▇; sudden onset of severe chest pain; sud...
View SourceView Similar (6)
RIGHT TO RECOVER PAYMENTS MADE IN ERROR. ‌ SECTION ER - EMERGENCY, URGENT CARE, FOLLOW-UP CARE WHAT ARE EMERGENCY SERVICES‌‌‌ Emergency Services Inside and Outside Keystone’s Limited Eligibility & Service Area
View SourceView Similar (4)
RIGHT TO RECOVER PAYMENTS MADE IN ERROR. If the HMO should pay for any contractually excluded services through inadvertence or error, the HMO maintains the right to seek recovery of such payment from the Provider or Member to whom such payment was made.
View Source

Related to RIGHT TO RECOVER PAYMENTS MADE IN ERROR

  • OUR RIGHT TO RECOVER PAYMENT If we make a payment under this policy and the person to or for whom payment was made has a right to recover damages from another we shall be subrogated to that right. That person shall do:

  • Our Right to Make Payments and Recover Overpayments If payments which should have been made by us according to this provision have actually been made by another organization, we have the right to pay those organizations the amounts we decide are necessary to satisfy the rules of this provision. These amounts are considered benefits provided under this plan and we will not have to pay those amounts again. If we make payments for allowable expenses, which are more than the maximum amount needed to satisfy the conditions of this provision, we have the right to recover the excess amounts from: • the person to or for whom the payments were made; • any other insurers; and/or • any other organizations (as we decide). As the subscriber, you agree to pay back any excess amount paid, provide information and assistance, or do whatever is necessary to aid in the recovery of this excess amount. The amount of payments made includes the reasonable cash value of any

  • Balance of Payments Difficulties Where either Party is in a serious balance of payments difficulties or under threat thereof, the Party concerned may in accordance with the conditions laid down within the framework of WTO/GATT 1994 and with Articles VIII and XIV of the Articles of Agreement of International Monetary Fund, adopt restrictive measures, which shall be of limited duration and may not go beyond what is necessary to remedy the balance of payments situation. The Party concerned shall inform the other Party forthwith of their introduction and present to the other Party, as soon as possible, a time schedule of their removal.

  • Non-Duplication of Payment or Benefits For purposes of clarity, in the event of a Qualifying Pre-CIC Termination, any severance payments and benefits to be provided to the Executive under Section 3(b) will be reduced by any amounts that already were provided to the Executive under Section 3(a). Notwithstanding any provision of this Agreement to the contrary, if the Executive is entitled to any cash severance, continued health coverage benefits, or vesting acceleration of any equity awards (other than under this Agreement) by operation of applicable law or under a plan, policy, contract, or arrangement sponsored by or to which any member of the Company Group is a party (“Other Benefits”), then the corresponding severance payments and benefits under this Agreement will be reduced by the amount of Other Benefits paid or provided to the Executive.

  • Allocation of Payments After Event of Default Notwithstanding any other provisions of this Credit Agreement, after the occurrence and during the continuance of an Event of Default with respect to any Borrower, all amounts collected from such Borrower or received by the Administrative Agent or any Lender on account of amounts outstanding under any of the Credit Documents shall be paid over or delivered as follows: FIRST, to the payment of all reasonable out-of-pocket costs and expenses (including without limitation reasonable outside attorneys’ fees other than the fees of in-house counsel) of the Administrative Agent or any of the Lenders in connection with enforcing the rights of the Lenders under the Credit Documents against such Borrower and any protective advances made by the Administrative Agent or any of the Lenders, pro rata as set forth below; SECOND, to payment of any fees owed to the Administrative Agent or any Lender by such Borrower, pro rata as set forth below; THIRD, to the payment of all accrued interest payable to the Lenders by such Borrower hereunder, pro rata as set forth below; FOURTH, to the payment of the outstanding principal amount of the Loans or Letters of Credit outstanding of such Borrower, pro rata as set forth below; FIFTH, to all other obligations which shall have become due and payable of such Borrower under the Credit Documents and not repaid pursuant to clauses “FIRST” through “FOURTH” above; and SIXTH, the payment of the surplus, if any, to whoever may be lawfully entitled to receive such surplus. In carrying out the foregoing, (a) amounts received shall be applied in the numerical order provided until exhausted prior to application to the next succeeding category and (b) each of the Lenders shall receive an amount equal to its pro rata share (based on each Lender’s Commitment Percentages) of amounts available to be applied.