Payment and Proceeds
Cal. INS § 10180
California Statutes
(
a) A disability insurer which negotiates and enters into a contract with professional providers to provide services at alternative rates of payment pursuant to
Section of the Insurance Code, shall give reasonable consideration to timely written proposals for contracting by licensed or certified professional providers. (
b) For the purposes of this section, the following
definitions are applicable: (1) “Reasonable consideration” means consideration in good faith of the terms of proposals for contracting prior to the time that contracts for alternative rates of payment are entered into or renewed. An insurer may specify the terms and conditions of contracting to assure cost efficiency, qualification of providers, appropriate utilization of services, accessibility, convenience to persons who would receive the provider’s services, and consistency with its basic method of operation, but shall not exclude providers because of their category of license. (2) “Professional provider” means a holder of a certificate or license under Division 2 (commencing with
Section 500) of the Business and Professions Code, or any initiative act referred to therein, except for those certified or licensed pursuant to
Article of
Chapter 5 (commencing with
Section 2050) or
Chapter 11 (commencing with
Section 4800), who may, within the scope of their licenses, perform the services of a specific benefit defined in the insurer’s policy. (
c) An insurer which has a contract with an institutional provider or with professional providers is not required by this
section to give consideration to contracting with professional providers who hold the same category of license or certificate and propose to serve a geographic area served adequately by the contracting providers that provide their professional services as employees or agents of that institutional or professional provider, or contract with that institutional or professional provider to provide professional services.