Common use of Communications with Enrollees Clause in Contracts

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.