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Don Levit 11/17/2008 01:47 PM
Brian: Thanks so much for providing this case. I have never heard of Coalition America. If I understood the case correctly, they are a clearinghouse which connects providers with various insurance companies, without the providers signing contracts. I have heard of something like this before, but was never able to put a name to any firm, or the words to how the linkage worked. It sounds like that by virtue of Coalition America having insurance company A and company B as "clients," that all the providers who have contracts with company A also have contracts with company B and vice versa. If that is the case, I wonder how a provider can have a contract without agreeing to anything? Don Levit
Brian S. King 11/17/2008 01:47 PM
Don, I don't know much about Coalition America but if you go to their website, www.coalitionamerica.com, you'll get more information. It sounds like CAI provides a variety of services for payers. They look to me a bit like Concentra Preferred Systems in at least some of their services. Your questions also make me wonder if CAI arranges for sharing of PPO contracts and discounts. As long as a company gets the consent of the provider to access the discount contract (and also provides the steerage the provider undoubtedly requires under the PPO contract), sharing discounts would be permissible it seems to me. The problem providers so often see is unauthorized access to discount contracts, the silent PPO problem that is so pervasive in the healthcare industry.
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