Section 500.3541 - Advocation by health professional.
THE INSURANCE CODE OF 1956 (EXCERPT)
Act 218 of 1956
500.3541 Advocation by health professional.
Sec. 3541.
A health maintenance organization shall not prohibit or discourage a health professional from advocating on behalf of an enrollee for appropriate medical treatment options pursuant to the grievance procedure in section 2213 or the patient's right to independent review act or from discussing with an enrollee 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 maintenance organization and the health professional 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. 2000, Act 252, Imd. Eff. June 29, 2000
Popular Name: Act 218
Popular Name: HMO