Hospital Privileges Requirement in Health Plan Participation Agreement Upheld
The West Virginia Intermediate Court of Appeals affirmed the decision of a lower court, concluding that a health plan’s termination of its participation agreement with a physician was appropriate since the agreement unambiguously required that the physician maintain privileges at a hospital within the plan’s network. When the physician’s privileges at a participating hospital were revoked, the health plan terminated the agreement. The physician sued, claiming, among other things, that his outpatient specialty did not require him to have hospital privileges. The court of appeals, in affirming the grant of summary judgment by the trial court in favor of the health plan, concluded that the participation agreement clearly required the physician to maintain privileges, no exception to this requirement had been approved by the plan, and the agreement expressly authorized the plan to immediately terminate the contract if the physician’s privileges were limited, suspended, or revoked. Chalifoux v. The Health Plan of W. Va., Inc.
