Bill Would Overhaul Health Insurance Provider Contracting
A bill has been introduced in the state House of Representatives that would overhaul and standardize contracting between physicians and insurers.
House Bill 1759 would afford physicians more protection during and after contract negotiations by:
- Requiring full disclosure of fee schedules, payment policies, and other contract provisions
- Regulating rental networks or silent PPOs
- Limiting retrospective audits to six months
- Requiring insurers to notify contracting physicians when contracts change
- Defining medical necessity of health services
- Creating medical policy development standards
In silent PPO arrangements, an insurer sells or rents its network to a third party that takes advantage of discounts the insurer negotiated with the physician.
"Legislation is needed to correct an unfair balance of power that works in favor of insurers. This bill would treat both parties as equals in the contractual relationship," said Daniel J. Glunk, MD.
Dr. Glunk is president of the Pennsylvania Medical Society, which has long advocated for improvements in insurance contracting.
Some of these protections were granted in the recent settlements with the Blues insurers, but they only apply for generally a four-year period.
By reducing administrative hassles for medical practices, HB 1759 also would help bring down health care costs in Pennsylvania.
A typical medical practice contracts with a dozen or more health insurers and must contend with each insurer's way of contracting, credentialing, preauthorizing, coding, billing, and reimbursing.
"This administrative redundancy and unnecessary complexity is a major source of waste, diverting billions of dollars each year from patient care," Dr. Glunk said.
Contact your legislators to support HB 1759. Use Capwiz to find your legislators.
Last Updated: 8/6/2009