Common use of Communications with Covered Persons Clause in Contracts

Communications with Covered Persons. Covered Persons are entitled to the full range of their Providers' opinions and counsel about the availability of Medically Necessary Services under the provisions of the State Contract. Any contractual provisions, including gag clauses or rules, that restrict a Provider's ability to advise Covered Persons about Medically Necessary treatment options violate federal law and regulations. (a) The Covered Person’s health status, medical care, or treatment options, including any alternative treatment that may be self-administered; (b) Any information the Covered Person needs in order to decide among all relevant treatment options; (c) The risks, benefits, and consequences of treatment or non-treatment; (d) The Covered Person’s right to participate in decisions regarding his or her health care, including the right to refuse treatment, and to express preferences about future treatment decisions; or (e) Information regarding the nature of treatment options including those that may not reflect United’s position or may not be covered by United. Subcontractor and Health Plan also shall not prohibit a Provider from advocating on behalf of a Covered Person in any grievance system, utilization review process, or individual authorization process to obtain necessary health care services.

Communications with Covered Persons. Covered Persons are entitled to the full range of their Providers' opinions and counsel about the availability of Medically Necessary Services under the provisions of the State Contract. Any contractual provisions, including gag clauses or rules, that restrict a Provider's ability to advise Covered Persons about Medically Necessary treatment options violate federal law and regulations. (ai) The Covered Person’s health status, medical care, or treatment options, including any alternative treatment that may be self-administered; (bii) Any information the Covered Person needs in order to decide among all relevant treatment options; (ciii) The risks, benefits, and consequences of treatment or non-treatment; (div) The Covered Person’s right to participate in decisions regarding his or her health care, including the right to refuse treatment, and to express preferences about future treatment decisions; or (ev) Information regarding the nature of treatment options including those that may not reflect United’s position or may not be covered by United. Subcontractor and Health Plan United also shall not prohibit a Provider from advocating on behalf of a Covered Person in any grievance system, utilization review process, or individual authorization process to obtain necessary health care services.