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2019 Health Law Library

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Managed Care: Contracting
  • All Products Affiliates Clauses
  • Contract Termination by Physicians and Continuity of Care Provisions
  • Contract Termination/Exclusion: Legal Challenges (Non-Antitrust)
  • Exclusivity Provisions and Membership Requirements in Contracts, Including Most-Favored-Nation Clauses
  • Failure to Receive Plan Referrals
  • Managed Care Contractual Protections
  • Termination/Exclusion of Physicians: Antitrust Challenges
  • Termination/Exclusion: Action Plan for Physicians
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All Products Affiliates Clauses

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Document: 7050
Chapter: Managed Care: Contracting
Pages:
8

  • Insurance/Reimbursement
  • Legal Issues
    Payor Issues
  • Legal Issues
    Payor Issues
    Managed Care

The following is an introduction to the document. To download the full text of the document, please log in.

Some health plans adhere to an “all products” policy that requires that physicians who contract with them for one of their products, such as a Preferred Provider Organization (PPO), also join all the plan’s other current and future products, including its Health Maintenance Organization (HMO) and more recently, its Medicare and Administrative Services Only (ASO) lines, its workers’ compensation panel, its health savings account qualified high deductible health plan (HDHP), and/or its California Health Benefit Exchange (“Exchange” or “Covered California”) product. Physicians who refuse to comply with this all products” policy may be terminated from the PPO. “All Products” clauses raise greater financial concerns now as more Medicare beneficiaries are becoming enrolled in Medicare Managed Care plans under the Medicare Advantage program and as the state expands Medicaid coverage to low-income adults. If physicians are forced to participate in plans such as Medicare Advantage, they may be receiving less than official Medicare rates. Because of the importance of this issue, the AMA has made efforts to clarify this issue with the Medicare Program. For more information, see CMA ON-CALL document #7206, “Medicare Managed Care (Medicare Advantage).”

Keywords:

  • CMA On-Call
  • HMOs
  • Managed Care
  • Payor Contracting
  • PPOs

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