Although physicians sometimes join together and form large group practices to counter this tremendous market advantage, their negotiating strength is still highly limited. Since contracts between health plans and physicians govern so many aspects of patient care and the physician-patient relationship, it is vitally important that physicians have meaningful input into these contract s . If enacted, the Quality Health Care Coalition Act of 1999 would give physicians the ability to negotiate on behalf of their patients and quality patient care. Administrative and clerical staff members, who sometimes have little or no medical education or training, often overrule the physician s sound medical treatment decisions in favor of less costly alternatives, even though these alternatives are less likely to benefit the patient. In addition, health plans often impose contract terms that prevent patients from getting all the information they need from their physicians.
Some contracts contain provisions that make it difficult for patients to see specialists.
Many contract provisions place burdensome administrative requirements on the physician which may delay care so long that the patient s condition gets much worse or, in some cases, gets so bad that it is no longer treatable. Under some contracts, patients can lose their physicians without prior notification and without the right for the physician to appeal the decision. The removal of a physician from a health plan is problematic under any circumstance. Physicians are then forced to participate in plans without knowing their medical policies, the type and number of patients they will see, the plans administrative requirements and, even, what they will be paid. Hold harmless clauses and the other contract terms described above illustrate the reason why physicians need a voice in formulating their relationships with health plans.