2005 Idaho Code - 41-2872 — HEALTH CARE PROVIDER CONTRACTS -- GRIEVANCE PROCEDURE

                                  TITLE  41
                                  INSURANCE
                                  CHAPTER 28
                    ORGANIZATION AND CORPORATE PROCEDURES
                         OF STOCK AND MUTUAL INSURERS
    41-2872.  HEALTH CARE PROVIDER CONTRACTS -- GRIEVANCE PROCEDURE. (1) Any
stock or mutual insurer (hereinafter insurance company) issuing benefits
pursuant to the provisions of this chapter shall be ready and willing at all
times to enter into health care provider service contracts with all qualified
health care providers of the category or categories which are necessary to
provide the health care services covered by the insurance company's policy of
insurance if such health care providers: are qualified under the laws of the
state of Idaho, desire to become participant health care providers of the
insurance company, meet the requirements of the insurance company, and
practice within the general area served by the insurance company.
    (2)  Nothing in this section shall preclude an insurance company from
refusing to contract with a health care provider who is unqualified or who
does not meet the terms and conditions of the participating provider contract
of the insurance company or from terminating or refusing to renew the contract
of a participating health care provider who is unqualified or who does not
comply with, or who refuses to comply with, the terms and conditions of the
participating health care provider contract including, but not limited to,
practice standards and quality requirements. The contract shall provide for
written notice to the participating health care provider setting forth any
breach of contract for which the insurance company proposes that the contract
be terminated or not renewed and shall provide for a reasonable period of time
for the participating health care provider to cure such breach prior to
termination or nonrenewal. If the breach has not been cured within such period
of time the contract may be terminated or not renewed. Provided however, that
if the breach of contract for which the insurance company proposes that the
contract be terminated or not renewed is a willful breach, fraud or a breach
which poses an immediate danger to the public health or safety, the contract
may be terminated or not renewed immediately.
    (3)  Every insurance company issuing benefits pursuant to this chapter
shall establish a grievance system for health care providers. Such grievance
system shall provide for arbitration according to chapter 9, title 7, Idaho
Code, or for such other system which provides reasonable due process
provisions for the resolution of grievances and the protection of the rights
of the parties.
    (4)  Subsections (1) and (2) of this section shall apply to health care
provider participation contracts entered into after July 1, 1994.