If a health maintenance organization determines that an enrollee has received health care services that the enrollee is not entitled to receive under the terms of the health maintenance agreement, the organization may not recover an amount above the actual cost of providing the health care service. This section does not apply if the enrollee gave or withheld information to the health maintenance organization with the intent to mislead or misinform the organization as to the enrollee's right to receive the health care services.
Section: Previous 21.86.070 21.86.075 21.86.078 21.86.080 21.86.087 21.86.090 21.86.100 21.86.110 21.86.120 21.86.130 21.86.140 21.86.150 21.86.160 21.86.170 21.86.180 NextLast modified: November 15, 2016