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MEMBER HOLD HARMLESS
Participating Providers are prohibited from balance billing Bravo Health Members including, but not
limited to, situations involving non-payment by Bravo Health, insolvency of Bravo Health, or Bravo
Health’s breach of its Agreement. Provider shall not bill, charge, collect a deposit from, seek
compensation or reimbursement from, or have any recourse against Members or persons, other than
Bravo Health, acting on behalf of Members for Covered Services provided pursuant to the contracted
Provider’s Agreement. The Provider is not, however, prohibited from collecting co-payments, co-
insurances or deductibles for non-covered services in accordance with the terms of the applicable
Member’s Benefit Plan.
In the event a Provider refers a Member to a non-Participating Provider without pre-approval, or
provides Excluded Services to Member, Provider must inform the Member in advance, in writing: (i)
of the service(s) to be provided; (ii) that Bravo Health will not pay for or be liable for said services;
and (iii) that Member will be financially liable for such services. In the event the Provider does not
comply with the requirements of this section, Provider shall be required to hold the Member harmless
as described above.
MEMBER CONFIDENTIALITY
At Bravo Health, we know Bravo Health Members’ privacy is extremely important to them, and we
respect their right to privacy when it comes to their personal information and health care. We are
committed to protecting our Member’s personal information. Bravo Health does not give out any
Member information to anyone without obtaining consent from an authorized person(s), unless we are
permitted to do so by law. Because you are a valued Provider to Bravo Health, we want you to know
the steps we have taken to protect Bravo Health’s Members’ privacy. This includes how we gather
and use their personal information. Bravo Health’s privacy practices apply to all of Bravo Health’s
past, present and future Members.
When a Member joins a Bravo Health Medicare Advantage plan, the Member agrees to give Bravo
Health access to Protected Health Information. Protected Health Information (“PHI”), as defined by
the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), is information created or
received by a health care Provider, health plan, employer or health care clearinghouse, that: (i) relates
to the past, present, or future physical or mental health or condition of an individual, the provision of
health care to the individual, or the past, present or future payment for provision of health care to the
individual; (ii) identifies the individual, or with respect to which there is a reasonable basis to believe
the information can be used to identify the individual; and (iii) is transmitted or maintained in an
electronic medium, or in any form or medium. Access to PHI allows Bravo Health to work with
Providers, like yourself, to decide whether a service is a Covered Service and pay your clean claims
for Covered Services using the Members’ medical records. Medical records and claims are generally
used to review treatment and to do quality assurance activities. It also allows Bravo Health to look at
how care is delivered and carry out programs to improve the quality of care Bravo Health’s Members
receive. This information also helps Bravo Health manage the treatment of diseases to improve Bravo
Health’s Members’ quality of life.
