ALL-OR-NONE: States Look at HMO-Doctor Contract Clauses
Consolidation in the health insurance industry is prompting state lawmakers nationwide to address doctors' concerns that insurers are using their growing market share to "bully" doctors into participating in all of an insurer's health plans or none at all. Lawmakers in Texas, Illinois and Rhode Island are considering bans on such all-or-nothing clauses, the North Dakota Senate has passed a ban and the Nevada insurance commissioner has barred such clauses. Aetna U.S. Healthcare CEO Richard Huber contends the requirement allows patients to switch plans without losing their doctors and saves administrative costs by allowing insurers to print one provider directory and negotiate one contract with doctors. But doctors argue they should have the flexibility to participate in plans that allow them to meet their ethical and financial goals, since some plans have higher reimbursements and fewer restrictions on treatment options and patient referrals. As the largest insurer to insist on an all-or-nothing clause, Aetna has drawn substantial criticism, and its looming merger with Prudential HealthCare has intensified concerns that its large market share will give it substantial leverage in forcing doctors to accept all-or-nothing contracts (Ornstein, Dallas Morning News, 3/15).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.