In this case many insurers will sell or resell the contracted physician or group so as not to retain any responsibility to insure the physician is paid. You should look through contracts for sections regarding payments to investigate this language. In the area of claims submission, there is language in contracts that if the claim is not billed within a stated time frame, the claim may be deemed waived and the physician may not bill any person or entity, but is required to write off the charges. Make sure there is a sufficient amount of time allowed for claims submission in any contract you sign. Another area which should be watched is the requirement for the physician or group to obtain consent to release medical information to the company and payer or representatives.
Most insurances require the individual obtaining insurance to sign a release of information.
Some contracts insert language requiring the physician to obtain consent from the patient to release medical information. This puts the burden upon the physician and one should investigate this language before signing a contract that includes it. Be sure you are aware of the malpractice limits required under contracts you sign. When we pointed out that these were certainly excessive in today s medical care environment, the provider representative agreed and stated the company leaves it in there unless the physician objects. Investigate contracts you are looking at for renewal and termination dates.