Meanwhile, the managed care organization is actively discouraging other doctors from referring to this surgeon. The word is out that this doctor isn't sufficiently cooperative with managed care. Managed care plans often make treatment decisions under the guise of deciding what's a covered benefit. When patients are harmed by delayed or denied treatment, the managed care plan seeks to indemnify itself from the consequences of its decision. This trick is accomplished by including clauses in the contract which hold the companies harmless from their decisions and shift liability from the plan to the treating physician.
Insurers frequently make unilateral changes in contracts terms.
Insurers reserve the right to change fee schedules depending upon the profitability of the company. Delays or denials of treatment are also made on this basis. Contracts have been issued which provide monthly changes in reimbursement for some procedures. Insurers may require physicians to participate in each of their plans, rather than just selected ones, even if doctors find the terms of some of the plans harmful to patients. This tactic allows insurers to market inferior plans to employers who may not recognize, or may not care, how bad the plan is.