Participating Provider Contract Negotiable?
July 19, 2012
I received a new contract to sign from one of the insurance companies. I was wondering if it is worth reviewing or if I should just sign. Are these contracts negotiable?
Thanks, Dr. H
Absolutely you should be reviewing your provider contracts. And, you may be surprised to know that oftentimes you are able to negotiate certain elements of those contracts with the insurer. Many doctors do not read their provider contracts or even retain copies; failing to do so is a terrible mistake, one your practice may pay dearly for should a contract be terminated without your consent. If you rely on third party payor beneficiaries as patients, as most doctors do, you may in fact be jeopardizing your relationship with a payor without realizing it if you are not aware of the terms of your contract. For example, many payors are sending out contract renewals requiring that the practice submit all claims electronically. Well, if you have not adopted EHR yet and you still file paper claims, signing that provider contract would create a situation where you automatically in breach. Another example I have seen recently is payors are requiring providers to agree in the contract that they will not refer to out-of-network specialists. Many times the generalist has no control over whether the patient sees an in-network or out-of-network specialist; in this instance the definition of referral is crucial, as is the intent of the insurer. As you may be aware, certain payors are terminating generalists for failing to control patient flow to in-network specialists.
While the bigger fish may have more bargaining power - part of the reason to consider joining an IPA or ACO (more to come in the near future) - the smaller fish should not be signing on the dotted line without review. In the future if you are concerned about this issue, keep an eye out for collective bargaining issues, potential legislation, etc. Market power is the key to bargaining power. Bottom line, when you receive a modified contract, review, ask questions, talk to your attorney, understand what you are agreeing to, because you will be obligating yourself and your practice to the terms of that document.
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at a residency/fellowship program?
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