Good point Robin. I've seen managed care contracts that do the reverse: payers who insist on provisions in the managed care contract to the effect that the provider has no recourse if there is a misquote of benefits! A lot will depend on who has the bargaining power and contracting experience.
by Brian S. King November 17, 2008 at 01:47 PM
Thank you for discussing this case. For those in other jurisdictions, ask for a clause in your contracts prohibiting an insurer from retroactively denying coverage for properly precertified / concurrently reviewed services so long as AT THE TIME CERTIFICATION REVIEW WAS GIVEN the provider accurately described the patient's condition and the services it intended to provide.
by Robin Fisk November 17, 2008 at 01:47 PM
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