Discharge Policy

Priority Health expects that providers will not discriminate against members because of race, color, ancestry, religion, age, sex, national origin, martial status, health status or disability.

Member discharges are not allowed if the sole purpose is related to incentive program rewards.  Member discharge requests near/at year end are subject to review by Priority Health.

Criteria for Discharging a Member

• Outstanding unpaid balance, including copayment, coinsurance, and deductible
• Non-compliant member (refer to Member Rights & Responsibilities)
• • Member cannot be considered non-compliant unless PCP has documentation supporting non-compliance.
  • PCP must have at least three documented attempts to contact the member before a member can be considered non-compliant.  Contacts can be made either by telephone or letter, but at least one must be a letter.  For example, PCP can call a member two times to remind them they need to set up or have missed an appointment, but the third contact must be a letter.  If there is no response from the member after the three contacts, the member can then be considered non-compliant.  Member names and addresses are available in Patient Profile.  Your Physician Account Executive can be contacted for assistance in obtaining current member information if unable to reach the member using Patient Profile data.
  • Member cannot be considered non-compliant if they are seeing participating specialists as part of the new "open network" policy.  If member is seeking services from a participating Primary Care Provider not in your office practice, contact your Physician Account Executive.

• No-shows for appointments or consistent lateness for appointments
• Patient displays disruptive or abusive behavior toward staff or physician
• Previous discharge under other insurance coverage