AMERICAN SPECIALTY HEALTH PLANS GROUP SUBSCRIBER AGMT 1998

~ ~ 7.01.02 Quality Assurance Reviews a. All complaints that involve quality of care issues shall be referred by the Member Services Manager to an ASHP Reviewing Chiropractor. b. Quality of care complaints that affect a Member's current treatment shall be immediately evaluated. The ASHP Reviewing Chiropractor shall consult with ASHP's Chiropractic Director and if necessary other Participating Chiropractors. c. Within five (5) business days of receipt of a written quality complaint, the Member will be sent a letter explaining the procedure for reviewing quality of care complaints. d. The Chiropractic Director or his designee shall be responsible for responding to a Member's question about his or her complaint and about the Quality Assurance Review process. In appropriate instances, the Chiropractic Director or his designee may arrange a meeting between the Member and a Participating Chiropractor. e. The Member's medical records and other relevant information shall be obtained from the appropriate providers, including Participating Chiropractors and shall be reviewed by the Chiropractic Director. f. After reviewing the Member's medical records and other relevant information, the Chiropractic Director shall present such records and information to ASHP's Quality Assurance Committee for its review and shall recommend corrective action against the Participating Chiropractor, if appropriate. The Quality Assurance Committee shall decide if corrective action is appropriate. g. If the Member has submitted a written complaint, the Member shall be notified in writing upon completion of the Quality Assurance Program review. The oral and written communications of the Quality Assurance Program and the results of the review shall remain confidential. h. T'he Chiropractic Director or a Participating Chiropractor on the Quality Assurance Committee shall monitor any corrective actions against a Participating Chiropractor. 7.02 Member Claims Against Participating Chiropractors. Member acknowledges ASHP's Participating Chiropractors are independent contractors and that ASHP does not assume responsibility for the acts of its Participating Chiropractors. Member claims for damages as a result of an injury caused or alleged to have been caused by an act or failure to act by a Participating Chiropractor are not governed by this Agreement. Member may seek appropriate legal action against such Participating Chiropractor. In the event of dispute between Member and a Participating Chiropractor which is not governed by this Agreement, upon mutual agreement between Member and the Participating Chiropractor, ASHP agrees to make available the Member Grievance Procedures described in Section 7.01.01 of this Agreement for resolution of such dispute. In such instance, the decisions of ASHP's Chiropractic Director, ASHP's President and the Board of Directors shall not be binding upon the parties except upon Agreement between the parties. Such grievance shall not be subject to binding arbitration, except upon Agreement between the parties. 7.03 Disputes Between ASHP and Group. All disputes between Group and ASHP shall be resolved by binding arbitration before the American Arbitration Association. Upon submission of a dispute to the American Arbitration Association, Group and ASHP agree to be bound by the rules of procedure and decision of the American Arbitration Association. The provisions of California Code of Civil Procedure, Section 1283.05, permitting the taking of depositions and the obtaining of discovery, shall be incorporated into and made applicable to this Agreement.