Physicians, other professionals and providers must act as individuals or small groups when negotiating contracts with health care plans. They have no market power to alter contracts in most instances, and contracts are issued on a take it or leave it basis. Even some large organizations including some prominent hospitals in Chicago have not had the market power to negotiate contracts, and health care plans have gone to providers who will agree to their terms and conditions. Physicians, other professionals and providers want to take care of their patients.
Patients change health plans usually joining the new plan offered by their employer.
Professionals and providers are forced to sign contracts with those new plans to continue providing care to their patients. In addition, most professionals and providers must participate in these contracts if they want to treat enough patients to have a viable business. This Act provides reasonable standardization and simplification of the terms and conditions of individual or group contracts with plans to facilitate understanding and comparisons. It also eliminates provisions contained in individual or group service contracts which may be unfair, deceptive or misleading in connection with the administrative requirements, services covered or with payment for services. It covers physicians, dentists, podiatrists, optometrists, physical therapists, and clinical psychologists and any other individual, or group, appropriately licensed to provide health care services.