When the Plan is the Primary Carrier
Provider Type
- Physicians
- Participating Physician Groups (PPG)
(does not apply to HSP)
- Hospitals
- Ancillary
When the plan is the primary carrier, the participating provider is entitled to bill the other carrier as secondary after the provider has received the plan's adjudication decision.
A member is not entitled to an itemized statement reflecting the cash value of the services provided by the participating provider and covered by the plan (compliance with a request for itemization could enable a member to obtain unjust payment from an insurer or to document an itemized tax deduction far in excess of the actual cost).
A member is entitled to a statement documenting copayments made to the participating provider and charges for services not covered by the plan.