550.1501b Conduct on behalf of or information provided to subscriber by health care provider; prohibition or discouragement by health care corporation.
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550.1501b Conduct on behalf of or information provided to subscriber by health care provider; prohibition or discouragement by health care corporation.
Sec. 501b.
A health care corporation shall not prohibit or discourage a health care provider from advocating on behalf of a subscriber for appropriate medical treatment options pursuant to the grievance procedure in section 404 or from discussing with a subscriber or provider any of the following:
(a)Health care treatments and services.
(b)Quality assurance plans required by law, if applicable.
(c)The financial relationships between the health care corporation and the health care provider including all of the following as applicable:
(i)Whether a fee-for-service arrangement exists, under which the provider is paid a specified amount for each covered service rendered to the participant.
(ii)Whether a capitation arrangement exists, under which a fixed amount is paid to the provider for all covered services that are or may be rendered to each covered individual or family.
(iii)Whether payments to providers are made based on standards relating to cost, quality, or patient satisfaction.
History: Add. 1997, Act 68 , Imd. Eff. July 15, 1997
Popular Name: Blue Cross-Blue Shield
Popular Name: Act 350