Common use of Selection of a Primary Care Physician Clause in Contracts

Selection of a Primary Care Physician. A. A Member must select a Primary Care Physician and may select any Primary Care Physician from CareFirst BlueChoice’s current list of Contracting Provider Primary Care Physicians. If the Primary Care Physician is not available, CareFirst BlueChoice will assist the Member in making another selection. SAMPLE B. A Member may change his or her Primary Care Physician at any time by notifying CareFirst BlueChoice. If the Member notifies CareFirst BlueChoice by the twentieth (20th) day of the month, CareFirst BlueChoice will make the change effective the first day of the next month. If the Member notifies CareFirst BlueChoice after the twentieth (20th) day of the month, CareFirst BlueChoice will make the change effective the first day of the second month following the notice. C. CareFirst BlueChoice may require a Member to change to a different Primary Care Physician if: 1. The Member’s Primary Care Physician is no longer available as a Primary Care Physician; or 2. CareFirst BlueChoice determines that the furnishing of adequate medical care is jeopardized by a seriously impaired physician-patient relationship between the Member and his or her Primary Care Physician due to any of the following: a) The Member engages in threatening or abusive behavior toward the physician, the physician’s staff or other patients in the office; or b) The Member attempts to take unauthorized controlled substances from the physician’s office or to obtain these substances through fraud, misrepresentation, and forgery or by altering the physician’s prescription order. D. If a change in Primary Care Physician is required, advance written notice will be given to the Member. The change is effective upon written notice to the Member. However, the Member may request a review of the action under the Benefit Determinations and Appeals Procedure. E. If a Member is required to change to another Primary Care Physician due to any of these circumstances, and there is a recurrence of the same or a similar situation with another Primary Care Physician, CareFirst BlueChoice may terminate the Member’s coverage upon thirty-one (31) days written notice. The Member’s refusal to follow a prescribed course of treatment will not, in and of itself, be cause for termination. CareFirst BlueChoice will not furnish any further benefits or services for a particular condition if the Member refuses to follow a prescribed course of treatment for that condition. If the Member disagrees with a prescribed course of treatment, the Member shall be permitted to receive a second opinion from another Contracting Provider. If the second physician disagrees with the prescribed course of treatment, CareFirst BlueChoice may not refuse to provide services or benefits for that particular condition, subject to this Agreement and CareFirst BlueChoice’s utilization review protocols and policies. SAMPLE

Selection of a Primary Care Physician. SAMPLE A. A Member must select a Primary Care Physician and may select any Primary Care Physician from CareFirst BlueChoice’s current list of Contracting Provider Primary Care Physicians. If the Primary Care Physician is not available, CareFirst BlueChoice will assist the Member in making another selection. SAMPLE. B. A Member may change his or her Primary Care Physician at any time by notifying CareFirst BlueChoice. If the Member notifies CareFirst BlueChoice by the twentieth (20th) day of the month, CareFirst BlueChoice will make the change effective the first day of the next month. If the Member notifies CareFirst BlueChoice after the twentieth (20th) day of the month, CareFirst BlueChoice will make the change effective the first day of the second month following the notice. C. CareFirst BlueChoice may require a Member to change to a different Primary Care Physician if: 1. The Member’s Primary Care Physician is no longer available as a Primary Care Physician; or 2. CareFirst BlueChoice determines that the furnishing of adequate medical care is jeopardized by a seriously impaired physician-patient relationship between the Member and his or her Primary Care Physician due to any of the following: a) The Member engages in threatening or abusive behavior toward the physician, the physician’s staff or other patients in the office; or b) The Member attempts to take unauthorized controlled substances from the physician’s office or to obtain these substances through fraud, misrepresentation, and forgery or by altering the physician’s prescription order. D. If a change in Primary Care Physician is required, advance written notice will be given to the Member. The change is effective upon written notice to the Member. However, the Member may request a review of the action under the Benefit Determinations and Appeals Procedure. E. If a Member is required to change to another Primary Care Physician due to any of these circumstances, and there is a recurrence of the same or a similar situation with another Primary Care Physician, CareFirst BlueChoice may terminate the Member’s coverage upon thirty-one (31) days written notice. The Member’s refusal to follow a prescribed course of treatment will not, in and of itself, be cause for termination. CareFirst BlueChoice will not furnish any further benefits or services for a particular condition if the Member refuses to follow a prescribed course of treatment for that condition. If the Member disagrees with a prescribed course of treatment, the Member shall be permitted to receive a second opinion from another Contracting Provider. If the second physician disagrees with the prescribed course of treatment, CareFirst BlueChoice may not refuse to provide services or benefits for that particular condition, subject to this Agreement and CareFirst BlueChoice’s utilization review protocols and policies. SAMPLEand

Selection of a Primary Care Physician. A. A Member must select a Primary Care Physician and may select any Primary Care Physician from CareFirst BlueChoice’s 's current list of Contracting Provider Primary Care Physicians. If the Primary Care Physician is not available, CareFirst BlueChoice will assist the Member in making another selection. SAMPLE. B. A Member may change his or her Primary Care Physician at any time by notifying CareFirst BlueChoice. If the Member notifies CareFirst BlueChoice by the twentieth (20th) 20th day of the month, CareFirst BlueChoice will make the change effective the first day of the next month. If the Member notifies CareFirst BlueChoice after the twentieth (20th) day of the month, CareFirst BlueChoice will make the change effective the first day of the second month following the notice. C. CareFirst BlueChoice may require a Member to change to a different Primary Care Physician if:: SAMPLE 1. The Member’s 's Primary Care Physician is no longer available as a Primary Care Physician; or 2. CareFirst BlueChoice determines that the furnishing of adequate medical care is jeopardized by a seriously impaired physician-patient relationship between the Member and his or her Primary Care Physician due to any of the following: a) The Member refuses to follow a treatment procedure recommended by his or her Primary Care Physician and the Primary Care Physician believes that no professionally acceptable alternative exists; b) The Member engages in threatening or abusive behavior toward the physician, the physician’s 's staff or other patients in the office; or bc) The Member attempts to take unauthorized controlled substances from the physician’s 's office or to obtain these substances through fraud, misrepresentation, and forgery or by altering the physician’s 's prescription order. D. If a change in Primary Care Physician is required, advance written notice will be given to the Member. The change is effective upon written notice to the Member. However, the Member may request a review of the action under the Benefit Determinations Determination and Appeals Appeal and Grievance Procedure. E. If a Member is required to change to another Primary Care Physician due to any of these circumstances, and there is a recurrence of the same or a similar situation with another Primary Care Physician, CareFirst BlueChoice may terminate the Member’s coverage upon thirty-one (31) days written notice. The Member’s refusal to follow a prescribed course of treatment will not, in and of itself, be cause for termination. CareFirst BlueChoice will not furnish any further benefits or services for a particular condition if the Member refuses to follow a prescribed course of treatment for that condition. If the Member disagrees with a prescribed course of treatment, the Member shall be permitted to receive a second opinion from another Contracting Provider. If the second physician disagrees with the prescribed course of treatment, CareFirst BlueChoice may not refuse to provide services or benefits for that particular condition, subject to this Agreement and CareFirst BlueChoice’s utilization review protocols and policies. SAMPLE

Selection of a Primary Care Physician. A. A Member must select a Primary Care Physician and may select any Primary Care Physician from CareFirst BlueChoice’s 's current list of Contracting Provider Primary Care PhysiciansProviders. If the Primary Care Physician is not available, CareFirst BlueChoice will assist the Member in making another selection. SAMPLE. B. A Member may change his or her Primary Care Physician at any time by notifying CareFirst BlueChoice. If the Member notifies CareFirst BlueChoice by the twentieth (20th) 20th day of the month, CareFirst BlueChoice will make the change effective the first day of the next month. If the Member notifies CareFirst BlueChoice after the twentieth (20th) 20th day of the month, CareFirst BlueChoice will make the change effective the first day of the second month following the notice. C. CareFirst BlueChoice may require a Member to change to a different Primary Care Physician if: 1. The Member’s 's Primary Care Physician is no longer available as a Primary Care Physician; or 2. CareFirst BlueChoice determines that the furnishing of adequate medical care is jeopardized by a seriously impaired physician-patient relationship between the Member and his or her Primary Care Physician due to any of the following: a) The Member refuses to follow a treatment procedure recommended by his or her Primary Care Physician and the Primary Care Physician believes that no professionally acceptable alternative exists; b) The Member engages in threatening or abusive behavior toward the physician, the physician’s 's staff or other patients in the office; or bc) The Member attempts to take unauthorized controlled substances from the physician’s 's office or to obtain these substances through fraud, misrepresentation, and forgery or by altering the physician’s 's prescription order. D. If a change in Primary Care Physician is required, advance written notice will be given to the Member. The change is effective upon written notice to the Member. However, the Member may request a review of the action under the [Benefit Determinations Determination and Appeals ProcedureAppeal and Grievance Procedures]. E. If a Member is required to change to another Primary Care Physician due to any of these circumstances, and there is a recurrence of the same or a similar situation with another Primary Care Physician, CareFirst BlueChoice may terminate the Member’s 's coverage upon thirty-one (31) 31 days written notice. The Member’s refusal to follow a prescribed course of treatment will not, in and of itself, be cause for termination. CareFirst BlueChoice will not furnish any further benefits or services for a particular condition if the Member refuses to follow a prescribed course of treatment for that condition. If the Member disagrees with a prescribed course of treatment, the Member shall be permitted to receive a second opinion from another Contracting ProviderPhysician. If the second physician disagrees with the prescribed course of treatment, CareFirst BlueChoice may not refuse to provide services or benefits for that particular condition, subject to this Agreement [In-Network] Evidence of Coverage and CareFirst BlueChoice’s utilization review protocols and policies. SAMPLE.

Selection of a Primary Care Physician. A. A Member must select a Primary Care Physician and may select any Primary Care Physician from CareFirst BlueChoice’s current list of Contracting Provider Primary Care Physicians. If the Primary Care Physician is not available, CareFirst BlueChoice will assist the Member in making another selection. SAMPLE B. A Member may change his or her Primary Care Physician at any time by notifying CareFirst BlueChoice. If the Member notifies CareFirst BlueChoice by the twentieth (20th) day of the month, CareFirst BlueChoice will make the change effective the first day of the next month. If the Member notifies CareFirst BlueChoice after the twentieth (20th) day of the month, CareFirst BlueChoice will make the change effective the first day of the second month following the notice. C. CareFirst BlueChoice may require a Member to change to a different Primary Care Physician if: 1. The Member’s Primary Care Physician is no longer available as a Primary Care Physician; or 2. CareFirst BlueChoice determines that the furnishing of adequate medical care is jeopardized by a seriously impaired physician-patient relationship between the Member and his or her Primary Care Physician due to any of the following: a) The Member engages in threatening or abusive behavior toward the physician, the physician’s staff or other patients in the office; or b) The Member attempts to take unauthorized controlled substances from the physician’s office or to obtain these substances through fraud, misrepresentation, and forgery or by altering the physician’s prescription order. D. If a change in Primary Care Physician is required, advance written notice will be given to the Member. The change is effective upon written notice to the Member. However, the Member may request a review of the action under the Benefit Determinations and Appeals Procedure. E. If a Member is required to change to another Primary Care Physician due to any of these circumstances, and there is a recurrence of the same or a similar situation with another Primary Care Physician, CareFirst BlueChoice may terminate the Member’s coverage upon thirty-one (31) days written notice. The Member’s refusal to follow a prescribed course of treatment will not, in and of itself, be cause for termination. CareFirst BlueChoice will not furnish any further benefits or services for a particular SAMPLE condition if the Member refuses to follow a prescribed course of treatment for that condition. If the Member disagrees with a prescribed course of treatment, the Member shall be permitted to receive a second opinion from another Contracting Provider. If the second physician disagrees with the prescribed course of treatment, CareFirst BlueChoice may not refuse to provide services or benefits for that particular condition, subject to this Agreement and CareFirst BlueChoice’s utilization review protocols and policies. SAMPLE.

Selection of a Primary Care Physician. A. A Member must select a Primary Care Physician and may select any Primary Care Physician from CareFirst BlueChoice’s current list of Contracting Provider Primary Care Physicians. If the Primary Care Physician is not available, CareFirst BlueChoice will assist the Member in making another selection. SAMPLE. B. A Member may change his or her Primary Care Physician at any time by notifying CareFirst BlueChoice. If the Member notifies CareFirst BlueChoice by the twentieth (20th) day of the month, CareFirst BlueChoice will make the change effective the first day of the next month. If the Member notifies CareFirst BlueChoice after the twentieth (20th) day of the month, CareFirst BlueChoice will make the change effective the first day of the second month following the notice. C. CareFirst BlueChoice may require a Member to change to a different Primary Care Physician if: 1. The Member’s Primary Care Physician is no longer available as a Primary Care Physician; or 2. CareFirst BlueChoice determines that the furnishing of adequate medical care is jeopardized by a seriously impaired physician-patient relationship between the Member and his or her Primary Care Physician due to any of the following: a) The Member engages in threatening or abusive behavior toward the physician, the physician’s staff or other patients in the office; or b) The Member attempts to take unauthorized controlled substances from the physician’s office or to obtain these substances through fraud, misrepresentation, and forgery or by altering the physician’s prescription order. D. If a change in Primary Care Physician is required, advance written notice will be given to the Member. The change is effective upon written notice to the Member. However, the Member may request a review of the action under the Benefit Determinations and Appeals Procedure. E. If a Member is required to change to another Primary Care Physician due to any of these circumstances, and there is a recurrence of the same or a similar situation with another Primary Care Physician, CareFirst BlueChoice may terminate the Member’s coverage upon thirty-one (31) days written notice. The Member’s refusal to follow a prescribed course of treatment will not, in and of itself, be cause for termination. CareFirst BlueChoice will not furnish any further benefits or services for a particular condition if the Member refuses to follow a prescribed course of treatment for that condition. If the Member disagrees with a prescribed course of treatment, the Member shall be permitted to receive a second opinion from another Contracting Provider. If the second physician disagrees with the prescribed course of treatment, CareFirst BlueChoice may not refuse to provide services or benefits for that particular condition, subject to this Agreement and CareFirst BlueChoice’s utilization review protocols and policies. SAMPLE.

Selection of a Primary Care Physician. A. A Member must select a Primary Care Physician and may select any Primary Care Physician from CareFirst BlueChoice’s 's current list of Contracting Provider Primary Care PhysiciansProviders. If the Primary Care Physician is not available, CareFirst BlueChoice will assist the Member in making another selection. SAMPLE. B. A Member may change his or her Primary Care Physician at any time by notifying CareFirst BlueChoice. If the Member notifies CareFirst BlueChoice by the twentieth (20th) 20th day of the month, CareFirst BlueChoice will make the change effective the first day of the next month. If the Member notifies CareFirst BlueChoice after the twentieth (20th) 20th day of the month, CareFirst BlueChoice will make the change effective the first day of the second month following the notice. C. CareFirst BlueChoice may require a Member to change to a different Primary Care Physician if: 1. The Member’s 's Primary Care Physician is no longer available as a Primary Care Physician; or 2. CareFirst BlueChoice determines that the furnishing of adequate medical care is jeopardized by a seriously impaired physician-patient relationship between the Member and his or her Primary Care Physician due to any of the following: a) a. The Member refuses to follow a treatment procedure recommended by his or her Primary Care Physician and the Primary Care Physician believes that no professionally acceptable alternative exists; b. The Member engages in threatening or abusive behavior toward the physician, the physician’s 's staff or other patients in the office; or b) c. The Member attempts to take unauthorized controlled substances from the physician’s 's office or to obtain these substances through fraud, misrepresentation, and forgery or by altering the physician’s 's prescription order. D. If a change in Primary Care Physician is required, advance written notice will be given to the Member. The change is effective upon written notice to the Member. However, the Member may request a review of the action under the Benefit Determinations Grievance and Appeals Appeal Procedure. E. If a Member is required to change to another Primary Care Physician due to any of these circumstances, and there is a recurrence of the same or a similar situation with another Primary Care Physician, CareFirst BlueChoice may terminate the Member’s 's coverage upon thirty-one (31) 31 days written notice. The Member’s 's refusal to follow a prescribed course of treatment will not, in and of itself, be cause for termination. CareFirst BlueChoice will not furnish any further benefits or services for a particular condition if the Member refuses to follow a prescribed course of treatment for that condition. If the Member disagrees with a prescribed course of treatment, the Member shall be permitted to receive a second opinion from another Contracting ProviderPhysician. If the second physician disagrees with the prescribed course of treatment, CareFirst BlueChoice may not refuse to provide services or benefits for that particular condition, subject to this Agreement Evidence of Coverage and CareFirst BlueChoice’s 's utilization review protocols and policies. SAMPLE.

Selection of a Primary Care Physician. A. A Member must select a Primary Care Physician and may select any Primary Care Physician from CareFirst BlueChoice’s current list of Contracting Provider Primary Care Physicians. If the Primary Care Physician is not available, CareFirst BlueChoice will assist the Member in making another selection. SAMPLE. B. A Member may change his or her Primary Care Physician at any time by notifying CareFirst BlueChoice. If the Member notifies CareFirst BlueChoice by the twentieth (20th) day of the month, CareFirst BlueChoice will make the change effective the first day of the next month. If the Member notifies CareFirst BlueChoice after the twentieth (20th) day of the month, CareFirst BlueChoice will make the change effective the first day of the second month following the notice. C. CareFirst BlueChoice may require a Member to change to a different Primary Care Physician if: 1. The Member’s Primary Care Physician is no longer available as a Primary Care Physician; or 2. CareFirst BlueChoice determines that the furnishing of adequate medical care is jeopardized by a seriously impaired physician-patient relationship between the Member and his or her Primary Care Physician due to any of the following: a) The Member engages in threatening or abusive behavior toward the physician, the physician’s staff or other patients in the office; oror SAMPLE b) The Member attempts to take unauthorized controlled substances from the physician’s office or to obtain these substances through fraud, misrepresentation, and forgery or by altering the physician’s prescription order. D. If a change in Primary Care Physician is required, advance written notice will be given to the Member. The change is effective upon written notice to the Member. However, the Member may request a review of the action under the Benefit Determinations and Appeals Procedure. E. If a Member is required to change to another Primary Care Physician due to any of these circumstances, and there is a recurrence of the same or a similar situation with another Primary Care Physician, CareFirst BlueChoice may terminate the Member’s coverage upon thirty-one (31) days written notice. The Member’s refusal to follow a prescribed course of treatment will not, in and of itself, be cause for termination. CareFirst BlueChoice will not furnish any further benefits or services for a particular condition if the Member refuses to follow a prescribed course of treatment for that condition. If the Member disagrees with a prescribed course of treatment, the Member shall be permitted to receive a second opinion from another Contracting Provider. If the second physician disagrees with the prescribed course of treatment, CareFirst BlueChoice may not refuse to provide services or benefits for that particular condition, subject to this Agreement and CareFirst BlueChoice’s utilization review protocols and policies. SAMPLE.

Selection of a Primary Care Physician. A. A Member must select a Primary Care Physician and may select any Primary Care Physician from CareFirst BlueChoice’s current list of Contracting Provider Primary Care Physicians. If the Primary Care Physician is not available, CareFirst BlueChoice will assist the Member in making another selection. SAMPLE. B. A Member may change his or her Primary Care Physician at any time by notifying CareFirst BlueChoice. If the Member notifies CareFirst BlueChoice by the twentieth (20th) day of the month, CareFirst BlueChoice will make the change effective the first day of the next month. If the Member notifies CareFirst BlueChoice after the twentieth (20th) day of the month, CareFirst BlueChoice will make the change effective the first day of the second month following the notice. C. CareFirst BlueChoice may require a Member to change to a different Primary Care Physician if: 1. The Member’s Primary Care Physician is no longer available as a Primary Care Physician; or 2. CareFirst BlueChoice determines that the furnishing of adequate medical care is jeopardized by a seriously impaired physician-patient relationship between the Member and his or her Primary Care Physician due to any of the following: a) The Member engages in threatening or abusive behavior toward the physician, the physician’s staff or other patients in the office; or b) The Member attempts to take unauthorized controlled substances from the physician’s office or to obtain these substances through fraud, misrepresentation, and forgery or by altering the physician’s prescription order.. Sample D. If a change in Primary Care Physician is required, advance written notice will be given to the Member. The change is effective upon written notice to the Member. However, the Member may request a review of the action under the Benefit Determinations and Appeals Procedure. E. If a Member is required to change to another Primary Care Physician due to any of these circumstances, and there is a recurrence of the same or a similar situation with another Primary Care Physician, CareFirst BlueChoice may terminate the Member’s coverage upon thirty-one (31) days written notice. The Member’s refusal to follow a prescribed course of treatment will not, in and of itself, be cause for termination. CareFirst BlueChoice will not furnish any further benefits or services for a particular condition if the Member refuses to follow a prescribed course of treatment for that condition. If the Member disagrees with a prescribed course of treatment, the Member shall be permitted to receive a second opinion from another Contracting Provider. If the second physician disagrees with the prescribed course of treatment, CareFirst BlueChoice may not refuse to provide services or benefits for that particular condition, subject to this Agreement and CareFirst BlueChoice’s utilization review protocols and policies. SAMPLE.

Selection of a Primary Care Physician. SAMPLE A. A Member must select a Primary Care Physician and may select any Primary Care Physician from CareFirst BlueChoice’s current list of Contracting Provider Primary Care Physicians. If the Primary Care Physician is not available, CareFirst BlueChoice will assist the Member in making another selection. SAMPLE. B. A Member may change his or her Primary Care Physician at any time by notifying CareFirst BlueChoice. If the Member notifies CareFirst BlueChoice by the twentieth (20th) day of the month, CareFirst BlueChoice will make the change effective the first day of the next month. If the Member notifies CareFirst BlueChoice after the twentieth (20th) day of the month, CareFirst BlueChoice will make the change effective the first day of the second month following the notice. C. CareFirst BlueChoice may require a Member to change to a different Primary Care Physician if: 1. The Member’s Primary Care Physician is no longer available as a Primary Care Physician; or 2. CareFirst BlueChoice determines that the furnishing of adequate medical care is jeopardized by a seriously impaired physician-patient relationship between the Member and his or her Primary Care Physician due to any of the following: a) The Member engages in threatening or abusive behavior toward the physician, the physician’s staff or other patients in the office; or b) The Member attempts to take unauthorized controlled substances from the physician’s office or to obtain these substances through fraud, misrepresentation, and forgery or by altering the physician’s prescription order. D. If a change in Primary Care Physician is required, advance written notice will be given to the Member. The change is effective upon written notice to the Member. However, the Member may request a review of the action under the Benefit Determinations and Appeals Procedure. E. If a Member is required to change to another Primary Care Physician due to any of these circumstances, and there is a recurrence of the same or a similar situation with another Primary Care Physician, CareFirst BlueChoice may terminate the Member’s coverage upon thirty-one (31) days written notice. The Member’s refusal to follow a prescribed course of treatment will not, in and of itself, be cause for termination. CareFirst BlueChoice will not furnish any further benefits or services for a particular condition if the Member refuses to follow a prescribed course of treatment for that condition. If the Member disagrees with a prescribed course of treatment, the Member shall be permitted to receive a second opinion from another Contracting Provider. If the second physician disagrees with the prescribed course of treatment, CareFirst BlueChoice may not refuse to provide services or benefits for that particular condition, subject to this Agreement and CareFirst BlueChoice’s utilization review protocols and policies. SAMPLE

Selection of a Primary Care Physician. A. A Member must select a Primary Care Physician and may select any Primary Care Physician from CareFirst BlueChoice’s 's current list of Contracting Provider Primary Care Physicians. If the Primary Care Physician is not available, CareFirst BlueChoice will assist the Member in making another selection. SAMPLE. B. A Member may change his or her Primary Care Physician at any time by notifying CareFirst BlueChoice. If the Member notifies CareFirst BlueChoice by the twentieth (20th) 20th day of the month, CareFirst BlueChoice will make the change effective the first day of the next month. If the Member notifies CareFirst BlueChoice after the twentieth (20th) day of the month, CareFirst BlueChoice will make the change effective the first day of the second month following the notice. C. CareFirst BlueChoice may require a Member to change to a different Primary Care Physician if: 1. The Member’s 's Primary Care Physician is no longer available as a Primary Care Physician; or 2. CareFirst BlueChoice determines that the furnishing of adequate medical care is jeopardized by a seriously impaired physician-patient relationship between the Member and his or her Primary Care Physician due to any of the following: a) The Member refuses to follow a treatment procedure recommended by his or her Primary Care Physician and the Primary Care Physician believes that no professionally acceptable alternative exists; b) The Member engages in threatening or abusive behavior toward the physician, the physician’s 's staff or other patients in the office; or bc) The Member attempts to take unauthorized controlled substances from the physician’s 's office or to obtain these substances through fraud, misrepresentation, and forgery or by altering the physician’s 's prescription order. D. If a change in Primary Care Physician is required, advance written notice will be given to the Member. The change is effective upon written notice to the Member. However, the Member may request a review of the action under the Benefit Determinations Determination and Appeals Appeal and Grievance Procedure. E. If a Member is required to change to another Primary Care Physician due to any of these circumstances, and there is a recurrence of the same or a similar situation with another Primary Care Physician, CareFirst BlueChoice may terminate the Member’s coverage upon thirty-one (31) days written notice. The Member’s refusal to follow a prescribed course of treatment will not, in and of itself, be cause for termination. CareFirst BlueChoice will not furnish any further benefits or services for a particular condition if the Member refuses to follow a prescribed course of treatment for that condition. If the Member disagrees with a prescribed course of treatment, the Member shall be permitted to receive a second opinion from another Contracting Provider. If the second physician disagrees with the prescribed course of treatment, CareFirst BlueChoice may not refuse to provide services or benefits for that particular condition, subject to this Agreement and CareFirst BlueChoice’s utilization review protocols and policies. SAMPLE

Selection of a Primary Care Physician. A. A Member must select a Primary Care Physician and may select any Primary Care Physician from CareFirst BlueChoice’s 's current list of Contracting Provider Primary Care Physicians. If the Primary Care Physician is not available, CareFirst BlueChoice will assist the Member in making another selection. SAMPLE. B. A Member may change his or her Primary Care Physician at any time by notifying CareFirst BlueChoice. If the Member notifies CareFirst BlueChoice by the twentieth (20th) 20th day of the month, CareFirst BlueChoice will make the change effective the first day of the next month. If the Member notifies CareFirst BlueChoice after the twentieth (20th) day of the month, CareFirst BlueChoice will make the change effective the first day of the second month following the notice. C. CareFirst BlueChoice may require a Member to change to a different Primary Care Physician if: 1. The Member’s 's Primary Care Physician is no longer available as a Primary Care Physician; or 2. CareFirst BlueChoice determines that the furnishing of adequate medical care is jeopardized by a seriously impaired physician-patient relationship between the Member and his or her Primary Care Physician due to any of the following: a) The Member refuses to follow a treatment procedure recommended by his or her Primary Care Physician and the Primary Care Physician believes that no professionally acceptable alternative exists; b) The Member engages in threatening or abusive behavior toward the physician, the physician’s 's staff or other patients in the office; or bc) The Member attempts to take unauthorized controlled substances from the physician’s 's office or to obtain these substances through fraud, misrepresentation, and forgery or by altering the physician’s 's prescription order.. SAMPLE D. If a change in Primary Care Physician is required, advance written notice will be given to the Member. The change is effective upon written notice to the Member. However, the Member may request a review of the action under the Benefit Determinations Determination and Appeals Appeal and Grievance Procedure. E. If a Member is required to change to another Primary Care Physician due to any of these circumstances, and there is a recurrence of the same or a similar situation with another Primary Care Physician, CareFirst BlueChoice may terminate the Member’s coverage upon thirty-one (31) days written notice. The Member’s refusal to follow a prescribed course of treatment will not, in and of itself, be cause for termination. CareFirst BlueChoice will not furnish any further benefits or services for a particular condition if the Member refuses to follow a prescribed course of treatment for that condition. If the Member disagrees with a prescribed course of treatment, the Member shall be permitted to receive a second opinion from another Contracting Provider. If the second physician disagrees with the prescribed course of treatment, CareFirst BlueChoice may not refuse to provide services or benefits for that particular condition, subject to this Agreement and CareFirst BlueChoice’s utilization review protocols and policies. SAMPLE