SHARP HEALTH PLAN GROUP AGREEMENTSharp Health Plan Group Agreement • September 28th, 2023
SHARP HEALTH PLAN GROUP AGREEMENTSharp Health Plan Group Agreement • February 23rd, 2022 • California
accordance with prevailing medical standards. Certain Members may, for personal reasons, refuse to accept procedures or treatments recommended by Plan Physicians. Plan Physicians may regard such refusal as incompatible with the continuance of a satisfactory physician-patient relationship and as obstructing the providing of proper medical care. If a Member refuses to follow a recommended treatment(s) or procedure(s), and the Plan Physician believes that no professionally acceptable alternative exists, the Member will be so advised. The Member may then contact Plan to obtain assistance in either: (a) choosing a new Primary Care Physician; or (b) seeking a referral to a specialty Plan Physician, as appropriate. If, after consulting with such other Plan Physician, the Member still refuses to follow a recommended treatment(s) or procedure(s), then the Member may contact Plan for a determination as to whether any Medically Necessary, medically superior (as determined by Plan), covered altern
SHARP HEALTH PLAN GROUP AGREEMENTSharp Health Plan Group Agreement • December 3rd, 2018 • California
third party; (b) not entering into any settlement agreement with the third party; (c) informing Plan promptly upon issuance of a judgment or damages award against a responsible third party; and (d) executing such assignments, lien confirmation documents, and other forms as are required for Plan to perfect its lien and to recover Plan Costs. Notwithstanding any language or provision to the contrary here or elsewhere, out-of-pocket maximums and other Member payment limitations established by contract or otherwise do not restrict Plan’s rights to recover the full amount of Plan Costs from a Third-Party Recovery. Plan may assign the right to recover Plan Costs from a Third-Party Recovery to Plan Providers and/or others.
