As just a matter of good business sense, physicians should make sure that they read and understand the terms of provider agreements that they are asked to sign; in some situations seeking the advice of an expert is helpful.
The Pennsylvania Medical Society (PAMED) and its affiliate, PMSCO, have a contract review program that links physicians with experienced attorneys who have agreed to provide a comprehensive review of provider contracts – at a discounted rate for members – to help them understand what they are signing.
As a result of member inquiries about Highmark’s new Participating Doctor Network and PremierBlue Network provider agreements and regulations, PAMED is seeking clarification from Highmark on a number of provisions, including the indemnification requirement, the ability to bill for independent contractors, and the requirement to participate in Highmark’s planned HIE.
PAMED also asked the Pennsylvania Department of Health to revisit its approval of the agreements, which took effect August 2011. PAMED is concerned, in particular, that these latest Highmark agreements and regulations took effect without public notice or the opportunity for comment; PAMED has submitted comments for the Department’s consideration.
Many of these issues raised in PAMED’s comments apply to other provider contracts as well. For the long run, PAMED is working hard to support legislation to ensure fair insurance contracts. House Bill 1763, strongly supported by PAMED, would help retain the provisions of the Love Settlement. Passage of fair contracting legislation would help address common physician concerns with provider agreements such as all programs requirements and the inability to terminate the relationship before changes in key terms.
Contact your legislators and urge them to support this bill.
PAMED members with additional questions about the Highmark provider agreements should call the Division of Practice Economics and Payer Relations at (800) 228-7823.