Dr. Milton Ware, a physician in the Riverside MCO's network of providers, is reimbursed under a fee schedule arrangement for medical services he provides to Riverside members. Dr. Ware's provider contract with Riverside contains a typical no-balance billing provision. One purpose of this provision is to:

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A no-balance billing provision in a provider contract prevents the provider from billing plan members for additional amounts beyond what the MCO pays for medical services. This ensures that plan members are not surprised by unexpected bills, and it also helps control healthcare costs by setting a clear and consistent payment amount for medical services. This provision does not necessarily prevent the provider from collecting coinsurance, copayment, or deductibles from plan members, as these are typically part of the member's responsibility under the terms of the plan. However, the provider cannot bill the member for any additional amounts beyond what the MCO pays.

Dr Milton Ware, a Physician in the Riverside MCO's Network