Hold Harmless Provisions
In accordance with standards established by the Centers for Medicare and Medicaid Services (CMS), under the terms of the provider participation agreements (PPAs), participating providers agree to hold the member harmless, and protect the member from incurring financial liabilities that are the legal obligation of a Medicare Advantage Organization (MAO) or its' participating providers. In no event, including but not limited to, nonpayment, termination, non-renewal, insolvency or breach of an agreement by Health Net, shall the provider, or any intermediary, bill charge, collect a deposit from or receive other compensation or remuneration from a member. Participating providers cannot take any recourse against a member, or a person acting on behalf of a member, for services provided.
This provision does not prohibit the following:
- Collection of applicable coinsurance, deductibles, or copayments, as specified in the member's Evidence of Coverage (EOC).
- Collection of fees for non-covered services, provided that the member was informed in advance, and in writing of the cost and elected to have non-covered services rendered.