Billing the Member
Values Health members can be billed for services you have provided. These instances include the following (please see additional details below):
- Non-covered services (only if you inform the member in writing before you deliver the services that he/she would be responsible for payment)
- Pharmacy copays
- Cost Sharing and Plan Benefits
Prohibition against Seeking Payment from Member
You must not request or accept payments from Values Health members, their families, or from others on behalf of the member for any of the following:
- Base rate changes made by PrimeWest Health
- Missed appointments
- The difference between insurance payments and usual and customary charges
- Services otherwise covered by PrimeWest Health, unless a copay or cost sharing applies
