Tennessee Code 56-27-129 – Settlement of dispute or controversy by commissioner – Review of decision
Current as of: 2023 | Check for updates
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Terms Used In Tennessee Code 56-27-129
- Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-27-102
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Medical service plan: means a plan or arrangement under which medical services are or may be rendered to a subscriber, a covered dependent or other beneficiary by a licensed physician and surgeon at the expense of a medical service plan corporation or other person, in consideration of periodical prepayments made by the subscriber or another in the subscriber's behalf prior to the occurrence of the condition calling for the rendition of medical or surgical services. See Tennessee Code 56-27-102
- Medical service plan corporation: means a corporation organized without capital stock and not for profit, and incorporated in accordance with §. See Tennessee Code 56-27-102
- Participating physician: means a doctor of medicine licensed to practice medicine and surgery in this state under title 63, chapter 6, who agrees in writing with a medical service plan corporation to perform the medical services specified in the subscription certificates issued by the corporation, and at the rates of compensation as shall be determined by the board of directors of the corporation, and who agrees to abide by the bylaws, rules and regulations of the corporation applicable to participating physicians. See Tennessee Code 56-27-102
- Person: includes a natural person, a copartnership, an association, a common-law trust or a corporation. See Tennessee Code 56-27-102
- Subscriber: means a person to whom a subscription certificate is issued by a medical service plan corporation that sets forth the beneficiaries and the kinds and extent of the medical services for which the corporation is liable to make payment. See Tennessee Code 56-27-102
- Subscription: includes a mark, the name being written near the mark and witnessed. See Tennessee Code 1-3-105
Any dispute or controversy arising between a medical service plan corporation and any participating physician or any physician desiring to become a participating physician, or any subscriber, or any other person whose subscription certificate has been cancelled, or to whom the corporation has refused to issue a certificate, may, within thirty (30) days after the dispute or controversy arises, be appealed by the person allegedly aggrieved to the commissioner, or a person or persons designated by the commissioner. After proper notice and hearing, the commissioner shall render a decision, which shall be binding on any medical service plan corporation or agent of the corporation, subject to judicial review.