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Provider Manual

Non-Covered Services

Last Updated on August 28, 2018

For Commercial plans, Security Health Plan agrees that Participating Providers may charge, bill and collect full charges from a Plan Participant for services that are deemed not to be Covered Services. In the event a Covered Service is considered investigative or experimental care, it is the Participating Provider's responsibility to have the Plan Participant sign in advance a waiver acknowledging that the investigative or experimental services are not authorized for reimbursement by Security Health Plan, and that the Plan Participant shall pay such charges. The waiver must be specific as to why the claim is not covered by Security Health Plan and as to the amount of patient liability.  The claim should be filed with the waiver attached or with the "GA" modifier on the service.  If the Participating Provider does not obtain a signed waiver from a Plan Participant prior to the procedure and the claim is denied as Provider Responsibility (Contract Obligation - CO), the Participating Provider cannot bill the Plan Participant for the non-covered service.