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Reviewing provider contracts worth the effort - Medical Economics



Q: Recently I received a new contract from one of the insurance companies my practice works with. Is it worth taking the time to review, or should I just sign it? Are these contracts negotiable?

A: Without question, you should review your provider contracts. You may be surprised to learn that often you can negotiate certain elements of the contracts with the insurer. Many doctors do not read their provider contracts, which is a terrible mistake for which you may pay dearly should a contract be terminated without your consent.

If you rely on patients who are third-party beneficiaries, as most doctors do, you may unknowingly jeopardize your relationship with a payer if you are not aware of the terms of your contract. For example, many payers use contract renewals that require a practice to submit all claims electronically. If you still file paper claims, signing that provider contract would create a situation in which you are automatically breaching its terms.

Another example I have seen recently is payers requiring providers to agree in the contract that they will not refer patients to out-of-network specialists. Many times you have no control over whether the patient sees an in-network or out-of-network specialist, so in this instance the definition of "referral" is crucial.

When you receive a contract, review it carefully, ask questions, talk to your attorney, and make sure you understand what you are agreeing to, because you will be obligating yourself and your practice to the terms of that document.

 








Answers to our readers questions were provided by Jennifer Kirschenbaum, JD, healthcare department manager for Kirschenbaum & Kirschenbaum PC, Garden City, New York.

 


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