Congress considers ban on managed care 'gag' clauses

Article Abstract:

A bill that would prohibit so-called 'gag' clauses in management care contracts with doctors is under consideration in Congress. However, while many in the industry support the bill and say that the clauses represent unsound public policy, others deny that managed care plans make use of such clauses. Witnesses at a House Commerce subcommittee hearing ranged from a former American Medical Assn president to a former medical reviewer, who alleged that she was rewarded for denying payment that led to the death of a patient. Legislation has already been proposed or passed in 13 states to ban the clauses, which restrict patient-doctor communication over treatment or payment issues.

Regulation, Licensing, and Inspection of Miscellaneous Commercial Sectors, Health Regulation NEC, Medical care, Practice, Managed care plans (Medical care), United States. Congress. House, Medical law, Gag orders

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Sounding out silent PPOs could save practice plenty

Article Abstract:

The American Medical Assn and the Dept of Justice are investigating silent or nondirected preferred provider organization (PPO), traditional 80/20 indemnity insurance plans with contracts for access to a PPO network. A physician who joins such a plan may accept lower rates to build up a practice, but patients may be offered few incentives to return. Doctors' contracts should prohibit such agreements, and at least a sample of patients' explanation of benefits should be audited to detect violations.

Preferred provider organizations (Medical care)

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Texas forces change in Aetna contracts

Article Abstract:

The Texas Insurance Dept has forced Aetna US Healthcare to change its contract with doctors in the state. According to the department, the contract was in violation of several state laws. Aetna's Texas contracts will no longer have wording that has been interpreted in other states as a 'gag' clause that restricts open physician-patient communication.

Hospital and medical service plans, Medical Care Insurance, Social policy, Texas, Health insurance, Aetna U.S. Healthcare Inc.

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