Introduction

As part of our overall Customer Service Strategy, we offer direct settlement for our Clients. bnl is selective in their choice of Healthcare Providers, and we ask Providers to follow our guidelines when providing services.

Provision of Services

We expect the Providers to deliver services to Insured Members in accordance with the benefits covering such Individuals. In providing these services, the Provider shall abide by the Terms of our Agreement with them and Healthcare Plans as set out in the "Schedule of Benefits".

As a Provider you should provide services to Members in the same manner that are available to other Patients. If an in-patient admission cannot be accommodated you can utilize bnl's participating Designated Healthcare Providers.

Our Providers commitment to provide medical services to our Members requires them to use their best efforts to provide all types of medical services in accordance with medical and professional ethics, rules and practices. This means that the Provider will be fully responsible for any omission, negligence or professional mistake in diagnosis, treatment, surgical operation or failure to provide required medical services, care or refusing to provide the treatment for Members.

The Provider shall not provide services to Individuals who do not hold valid bnl Membership Cards.

All inadmissible Claims in respect of treatments excluded as defined in the Member's Schedule of Benefits and the General "Exclusion List" will not be reimbursed by bnl.

The Provider agrees to co-operate with bnl Staff for the purposes of completing Claim Forms in full, obtaining pre-authorization and additional authorization(s) for extension of treatment(s) in time, concurrent review and other utilization review activities.

If the coverage of any service cannot be clearly determined by reference to the provisions of the Provider's Agreement and the Schedule of Benefits, the Provider will contact bnl for clarification and approval. bnl will review and decide on the matter and will advise the Provider accordingly in writing.

Provider Fraud

If bnl finds that any fraudulent activities have been conducted by or concealed by the Provider in its dealing with bnl or its Members, bnl has the right to suspend all business activities with the Provider, withhold Claims payments and report any illegality, fraud and misdemeanour to the National Health Regulatory Authority, the Ministry of Health and any other relevant authorities.

Provider Fraud