Petitioner Mark Zembsch was employed by the City of Berkeley and eligible for group health insurance coverage under a group hospital and professional service agreement between the city and Health Net of California (“Health Net”). On May 9, 2002, Zembsch signed a form emolling himself, his wife, and his two children in a Health Net HMO plan. Alta Bates Medical Group “Alta Bates”) was the contracting physician group for the Zembsch family’s plan. Health Net’s plan permitted members to receive a standing referral to a specialist without first receiving a specific referral from the member’s primary care physician for each visit. A standing referral is authorized by the plan if it is determined to be necessary by the primary care physician, Health Net’s medical director, and the member.
Lees het volledige artikel door op de onderstaande link te klikken.
