Communications with Enrollees. Doctor has the right and is encouraged by CCMI to discuss with each Enrollee his or her pertinent details regarding the diagnosis of the Enrollee’s condition, the nature and purpose of any recommended procedure, the potential risks and benefits of any recommended treatment, and any reasonable alternatives to such recommended treatment. Doctor may discuss CCMI’s and health plan company’s provider reimbursement methodology (including a good faith estimate of the reimbursement the Doctor expects to receive for services) with an Enrollee or patient, subject to Doctor’s general contractual and ethical obligations not to make false or misleading statements. CCMI has the right to disclose to any Enrollee the reason(s) for modifications or denials relating to authorizations such as, by way of example and not limitation, failure to promptly and adequately document Chiropractic Necessity.
Communications with Enrollees. Notwithstanding any other provision in this Agreement and regardless of any benefit or coverage exclusions associated with an Enrollee’s Plan, Provider shall not be prohibited from discussing fully with an Enrollee any issues related to the Enrollee’s health including recommended diagnostic tests, treatments, treatment alternatives, treatment risks and the consequences of any benefit coverage or payment decisions made by LIBERTY IPA and/or Payor or any other party. LIBERTY IPA and/or Payor shall not refuse to allow, or to continue, the participation of an eligible provider, or refuse to compensate Provider in connection with Covered Services rendered, solely because Provider has in good faith communicated with one or more of current, former or prospective Enrollees regarding the provisions, terms or requirements of a Plan as they relate to the health needs of such Enrollee.
