Chapter 10.C.3 (or 4.C.3) -- Managed Care Networks and Contracting

Managed Care Networks:

On laws protecting physicians from deselection, see Linda C. Fentiman, Patient advocacy and termination from managed care organizations: Do state laws protecting health care professional advocacy make any difference?, 82 Neb. L. Rev. 508-574 (2003).

Managed Care Contracting:

A good source for practical information an analysis of managed care contracting issues is the Model Managed Care Agreement drafted by the AMA.

As the Managed Care Contracting problem illustrates, insurers sometimes ask physicians to sign contracts that have "blind" payment terms in which physicians agree to  fee schedules that not only are subject to change, but also that the company keeps secret, even from the contracting parties.   Regarding this practice, one court held that unilateral changes in fee schedules are permissible, but not secret fee schedules, since otherwise physicians have no way to determine if they've been paid the correct amounts.  Medical Assoc. of Georgia v. Blue Cross and Blue Shield of Georgia, 536 S.E.2d 184 (Ga. App. 2000).
 

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