Common use of Refusal to Accept Treatment Clause in Contracts

Refusal to Accept Treatment. Plan Physicians use their best efforts to recommend Medically Necessary and appropriate services in a manner compatible with a Member's wishes, insofar as this can be done consistently with the Plan Physician's judgment regarding proper medical practice in 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 alternative procedure(s) or treatment(s) is available to the Member. If Plan advises the Member to the contrary, or if the Member refuses to undergo any such other Medically Necessary, medically superior covered alternative procedure(s) or treatment(s), the Member may appeal Plan's decision through Plan's grievance procedure.

Refusal to Accept Treatment. Plan Physicians use their best efforts to recommend Medically Necessary and appropriate services in a manner compatible with a Member's wishes, insofar as this can be done consistently with the Plan Physician's judgment regarding proper medical practice in 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 the 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 the Plan for a determination as to whether any Medically Necessary, medically superior (as determined by the Plan), covered alternative procedure(s) or treatment(s) is available to the Member. If the Plan advises the Member to the contrary, or if the Member refuses to undergo any such other Medically Necessary, medically superior covered alternative procedure(s) or treatment(s), the Member may appeal the Plan's ’s decision through the Plan's ’s grievance procedure.