In California Medical Assn. v. Aetna U.S. Healthcare of California, Inc. (2001) 94 Cal.App.4th 151, the plaintiff, California Medical Association, Inc. (CMA), was the assignee of claims owned by physicians and medical groups. CMA sued two health care insurers for payments allegedly owed to physicians for services provided to enrollees in health care service plans operated by defendants. The decision explains the typical contractual relationships under which patient care is provided and reimbursed under the Knox-Keene Act. The defendant insurers entered into "Defendant-Enrollee Agreements" with their enrollees that imposed obligations upon defendants to pay for services rendered by physicians to enrollees. They also entered into "Defendant-Intermediary Agreements" with various contracting entities including large medical groups, independent practice associations and limited Knox-Keene license plans. Under those agreements, defendants paid their agent intermediaries to perform specific tasks on behalf of defendants, including signing up panels of primary care and specialty physicians, processing claims and making payments to physicians. The intermediaries then entered into agreements with physicians to provide health services to defendants' enrollees. To participate in the managed care plans offered by the defendants, physicians were required to enter into "Intermediary-Physician Agreements" or otherwise be accepted into panels of providers established by the intermediaries. Once care was provided to an enrollee, the physician submitted a claim to defendants through the intermediaries. According to the CMA, the Intermediary-Physician Agreements required the providers to " 'look solely' " to intermediaries for payment for the services they provided to enrollees by the physicians. (Aetna, supra, 94 Cal.App.4th at pp. 156-157.) But due to insolvency, many intermediaries failed to pay physicians for these services. The defendants maintained their contractual relationship with these insolvent intermediaries, despite knowledge of their financial instability and continued to make payments to them. The defendants denied repeated demands for direct payment by the physicians, while still collecting premiums from their enrollees. (Aetna, supra, 94 Cal.App.4th at p. 157.) In Aetna, CMA argued that section 1371 imposed an obligation on the insurer to pay for all covered medical services rendered by physicians to defendants' enrollees even when defendants purported to delegate such obligation to intermediaries. It further alleged that the defendants failed to make these payments within the time frames specified in section 1371, and that any contractual provision purporting to waive these requirements or other portions of the statute was unlawful. (Aetna, supra, 94 Cal.App.4th at p. 160.) CMA asserted that the defendants were obligated to the physicians under the nonwaiver clause we have quoted, despite language in the intermediary agreements imposing the ultimate responsibility to pay the physician's claims on the intermediaries. The Aetna court held that the statutory nonwaiver clause "simply means that section 1371's time limits and other procedural requirements must be satisfied even when health plans have delegated their payment obligations to contracting entities under risk-shifting agreements consistent with other Knox-Keene provisions." (Aetna, supra, 94 Cal. App. 4th at p. 161.) The court also examined the legislative history of section 1371 and found nothing "indicating that section 1371 was intended to impose an obligation on health plans to pay treating physicians where the plans had no contractual obligation to do so." (Aetna, supra, 94 Cal.App.4th at p. 163.) Based on this history, the court concluded that the nonwaiver clause was "intended simply to require contracting entities such as Intermediaries to make timely compliance with the statute's procedures for handling claims"; CMA failed to identify anything in the legislative history indicating that section 1371's statutory nonwaiver clause was intended to require health plans to pay treating physicians absent a contractual obligation to do so. (Aetna, at p. 163.) The Aetna court also noted that the Department of Corporations had denied a request by the CMA that it issue a regulation to make health plans the primary obligors for payments of claims notwithstanding contractual provisions to the contrary. (Aetna, supra, 94 Cal.App.4th at pp. 163-164.)