Reso 2010-1529 - Laserfiche WebLink

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I) ) XV. DISCLAIMER OF LIABILITY ) 15.01 Neither Subscribing Group nor its agents, servants or employees, nor any Member is the agent or representative of AvMed, and none of them shall be liable for any acts or omissions of AvMed, its agents or employees or of a Participating Hospital, or a Participating Physician, or any other person or organization with which AvMed has made or hereafter shall make arrangernents for the performance of services under this Contract. 15.02 Neither Subscribers of Subscribing Group nor their Dependents shall be liable to AvMed or Participating Providers except as specifically set forth herein, provided all procedures set forth herein are followed. 15.03 Neither AvMed nor its agents, servants or employees, nor any Member is the agent or representative of the Subscribing Group, and none of them shall be liable for any acts or omissions of Subscribing Group, its agents or employees or any other person representing or acting on behalf of Subscribing Group. 15.04 AvMed does not directly employ any practicing physicians nor any Hospital personnel or physicians. These health care providers are independent contractors and are not the agents or employees of AvMed. AvMed shall be deemed not to be a health care provider with respect to any services performed or rendered by any such independent contractors. Participating Providers maintain the physician/patient relationship with Members and are solely responsible for all Medical Services which Participating Providers render to Members. Therefore, AvMed shall not be liable for any negligent act or omission committed by any independent practicing physicians, nurses, or medical personnel, nor any Hospital or health care facility, its personnel, other health care professionals or any of their employees or agents who may, from time to time, provide Medical Services to a Member of AvMed. Furthermore, AvMed shall not be vicariously liable for any negligent act or omission of any of these independent health care professionals who treat a Member of AvMed. 15.05 Certain Members may, for personal reasons, refuse to accept procedures or treatment recommended by Participating Physicians. Participating Physicians rnay regard such refusal to accept their recommendations as incompatible with the continuance of the physician/patient relationship and as obstructing the provision of proper medical care. If a Member refuses to accept the medical treatment or procedure recommended by the Participating Physician and if, in the judgment of the Participating Physician, no professionally acceptable alternative exists or if an alternative treatment does exist but is not recommended by the Participating Physician, the Member shall be so advised. 15.06 Ifthe Member continues to refuse the recommended treatment or procedure, AvMed may terminate the Member's coverage under this Contract as set forth in Part IX, Subsection 9.01.05. III ) XVI. GRIEVANCE PROCEDURE A grievance is any complaint other than one that involves a request (Claim) for benefits, or an appeal as described in Section 16.02, below. Members have the right to a review of any complaint regarding the services or benefits covered under this Plan. AvMed encourages the informal resolution of cornplaints. If you have a complaint, you or someone you name to act on your behalf (your authorized representative) rnay call AvMed's Member Services Department, and a Member Services Representative will try to resolve your cornplaint for you over the phone. If you ask for a written response, or if the complaint is related to quality of care, AvMed will respond to you in writing. The Member Services Department can also tell you how to name your authorized representative. If a Member's complaint carmot be resolved informally (over the telephone), the complaint may be submitted to AvMed in writing, through the formal Member grievance process. The procedures for filing a grievance are described in 16.01, below. 38 A V -Gl 00-2009 MP-5319 (10/09)