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Managed Care: Contracting
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  • Failure to Receive Plan Referrals
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Failure to Receive Plan Referrals

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Document: 7056
Chapter: Managed Care: Contracting
Pages:
7

  • Advocacy
  • Insurance/Reimbursement
  • Practice Management
  • 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.

Physicians often ask if they have any legal recourse when an independent practice association (IPA), health maintenance organization (HMO), or preferred provider organization (PPO), utilization review company, or other entity refuses to authorize referrals to them and/or otherwise casts aspersionson their professional reputation. As discussed in the attached sample letter from a physician to a plan, there are legal claims which may be available to prohibit such unfair actions. Depending on the circumstances, you may wish to send a letter to the entity you believe is treating you unfairly, similar to the attached sample letter. This document touches upon the legal requirements for plans to publish lists of their contracting providers.

Keywords:

  • Managed Care

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