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Sponsor shall be responsible for the cost of Provider's review of Participant's medical records, the cost of any pre- admission testing or treatment provided by a Provider, any expenses related to Travel Services, and any other fees, costs, or expenses actually incurred. EDH will refund any deductible received by the Patient within fifteen (15) business days of cancellation of the Episode of Care and will promptly notify Sponsor of such refund of deductible. Any such charges will be listed in an Invoice. 4.7 Urgent or Emergency Medical Services. If at any time during an Episode of Care, Provider determines that any Medically Necessary Service that is not otherwise included within the Case Rate must be performed on an urgent or emergency basis to preserve the life or health of the Participant, Sponsor will be responsible for payment of the Provider'scharges for any such Medically Necessary Service as part of the Episode of Care. The amounts of such charges will be calculated and charged by EDH according to the pricing terms set :forth in the agreement between EDH and the Provider.. Any such charges will be listed in an Invoice. 4.8 Elective Changes by Participant. This Agreement does not include or permit authorization of elective changes by a Participant after a Provider has accepted the Participant. Moreover, this Agreement does not cover changes to other factors reasonably under control of the Participant during an Episode of Care. Any request by Participant to Provider for such elective changes and Provider's decision to render such elective services will be considered outside of the Network and not subject to the scope of this Agreement. EDH will have no obligation or responsibility with respect to such elective services. 4.9 Termination of an Episode of Care. EDH's obligations under this Agreement extend only through the end of an Episode of Care, which, as defined in Article 1 of this Agreement, terminates upon discharge of a Participant. In the event an Episode of Care extends thirty (30) days beyond the date the Participant was originally admitted by a Provider, the Episode of Care shall be deemed terminated. The Parties acknowledge and agree that EDH shall have no obligations or liability with respect to services rendered by a Provider after the termination of an Episode of Care. The Parties further acknowledge and agree that payment for any services rendered by 'a Provider after the termination of an Episode of Care shall be the responsibility of the Participant, Sponsor, or the Plan. 4.10 Proof of Patient Financial Responsibility. EDH or a Provider may require proof of a Participant's ability to pay for additional or unforeseen services requested or required during an Episode of Care. Such assurance may take the form of proof of coverage under the Plan or a deposit, surety, or letter of credit in such amount as reasonably required. 4.11 Disputes Regarding Adiustments to Price. In the event that a Participant, Sponsor, or the Plan Administrator on behalf of Sponsor makes a factually supported assertion that a physician -initiated urgent or emergency service was not a Medically Necessary Service, EDH will retain an independent arbitrator having appropriate clinical expertise for the purpose of determining the medical necessity of such care. EDH will require Provider to supply to the arbitrator such Participant's medical records as the arbitrator may reasonably request. If the arbitrator determines that all or a portion of such care was not a Medically Necessary Service, the charges associated with such care will be canceled or reduced pro -rata with such determination. Each party to the arbitration will bear its respective arbitration expenses and each will pay its pro -rata portion of the arbitrator's charges and expenses. The arbitrator's decision shall be final and binding upon Provider, Participant, Sponsor, and/or Plan Administrator, as applicable. 4.12 Delinquent Payment. If Sponsor fails to pay EDH any amount due to a Provider within sixty (60) days following Sponsor's receipt of an Invoice itemizing such amount, EDH may notify the Provider of such failure, and EDH may engage in good faith efforts to facilitate resolution of any payment issues or disputes. If EDH is unable to resolve such payment issues or disputes within thirty (30) days of such engagement, EDH may notify the Provider, and the Provider may terminate its agreement with EDH with regard to the Sponsor failing to make payment. The Provider may then seek to recover payment for amounts due directly from Sponsor. In such event, Sponsor will lose the benefit of any contractual rates setforth in EDH's agreements with the Provider, and Sponsor shall be responsible for the full amount of the Provider's charges. This provision is in addition to, and not in lieu of, any other rights and remedies available to EDH under this Agreement, at law, or in equity. -7- 58