PHYSICIANS, HOSPITALS AND OTHER PROVIDER OPTIONS Sample Clauses
The "Physicians, Hospitals and Other Provider Options" clause defines the choices available to individuals regarding the selection of healthcare providers under a given plan or agreement. It typically outlines whether participants can choose any licensed physician, hospital, or healthcare provider, or if they are required to use a specific network of providers for their medical care. For example, the clause may specify if out-of-network care is covered or if referrals are needed for specialist visits. Its core function is to clarify the scope of provider selection, helping participants understand their options and any limitations, thereby preventing confusion and ensuring informed healthcare decisions.
PHYSICIANS, HOSPITALS AND OTHER PROVIDER OPTIONS. 7.1 Provider and Service Arrangement. AvMed is committed to arranging for comprehensive prepaid Health Care Services rendered to its Members through the Empower Plan’s network of contracted independent Physicians and Hospitals and other independent HealthCare Providers, and Non-Participating Providers, as described in this Contract, under reasonable standards of quality health care. The professional judgment of a Physician licensed under Chapter 458 (Physician), 459 (osteopath), 460 (chiropractor) or 461 (podiatrist), Florida Statutes (or if outside Florida, applicable state law), concerning the proper course of treatment of a Member shall not be subject to modification by AvMed, its Board of Directors, officers or administrators. However, this Section is not intended to and shall not restrict any Utilization Management Program established by AvMed.