§ 4913 — Conflict of interest

§ 4913. Conflict of interest. (a) No external appeal agent or officer,\ndirector, or management employee thereof; or clinical peer reviewer\nemployed or engaged thereby to conduct any external appeal pursuant to\nthis title, shall have any material professional affiliation, material\nfamilial affiliation, material financial affiliation, or other\naffiliation prescribed pursuant to regulation, with any of the\nfollowing:\n (1) the health care plan;\n (2) any officer, director, or management employee of the health care\nplan;\n (3) any health care provider, physician's medical group, independent\npractice association, or provider of pharmaceutical products or services\nor durable medical equipment, proposing to provide or supply the health\nservice;\n (4) the facility at which the health service would be provided;\n (5) the developer or manufacturer of the principal health service\nwhich is the subject of the appeal; or\n (6) the insured whose health care service is the subject of the\nappeal, or the insured's designee.\n (b) Notwithstanding subsection (a) of this section, the superintendent\nshall promulgate regulations to minimize any conflict of interest where\nsuch conflict may be unavoidable.\n