Podiatrists Hearing Request Before Terminating An Agreement With
In Ambrosino v. Metropolitan Life Ins. Co. (N.D.Cal. 1995), a plaintiff podiatrist entered into an agreement with the defendant health insurance company.
The agreement provided that the plaintiff was an independent contractor and the agreement could be terminated with or without cause by giving 30 days' notice of termination.
The plaintiff was placed on probation by his governing board for a short-term chemical dependency problem and his conduct while suffering from that chemical dependency.
When the defendant learned of the plaintiff's problems, it recommended plaintiff's delistment for failure to meet the criteria for retention.
It gave the plaintiff 30 days' notice of termination of the agreement. the plaintiff requested a hearing; the defendant denied the request and terminated the agreement. ( Id. at pp. 440-441.)
The court cited Delta Dental Plan for the proposition that "the common law right to fair procedures has recently been held to extend to health care providers' membership in provider networks such as that operated by Defendant, because such managed care providers control substantial economic interests." (Ambrosino v. Metropolitan Life Ins. Co., supra, 899 F. Supp. at p. 445.)
And it pointed out that there was no dispute that the defendant "controlled substantial economic interests" affecting the plaintiff, in that about 15 percent of the plaintiff's patients were insured by defendant. (Ibid.)
It therefore concluded that the plaintiff "had a common law right to fair procedures, including the right not to be expelled from membership for reasons which are arbitrary, capricious and/or contrary to public policy" (ibid.), the at-will provision in his agreement with defendant notwithstanding ( id. at p. 446).