MENU Close
Close
  • Home
  • Services
  • Attorneys
  • Resources
  • News & Events
  • About Us
  • Contact Us
  • Join our Team
Search
Back
    Quick Links:
    Join Webinar
    Read News
    Our Location
    A
    Alternative Dispute ResolutionAntitrust & Trade RegulationAppellate Practice
    B
    Banking & Financial ServicesBankruptcy, Creditors’ Rights, and Financial RestructuringBeer LawBusiness Law
    C
    Cannabis LawConstruction LawCriminal Defense
    E
    Economic Development LawElder Care & Special Needs LawElectronic Discovery ("E-Discovery")Environmental LawEstate Planning and Administration & Wealth PreservationExecutive Compensation, Employment, ERISA, and Employee Benefits
    F
    Food, Beverage & HospitalityFranchise Law
    H
    Health Care & Life SciencesHealth Care ProvidersHigher EducationHospitals and Health Networks
    I
    ImmigrationInsurance CoverageIntellectual PropertyIntellectual Property Litigation, Arbitration, and Dispute ResolutionIntellectual Property Portfolio Strategy, Management & LicensingInternational BusinessInternet Law
    L
    Labor & EmploymentLiquor Law, Licensing, Manufacturing, and DistributionLitigation
    M
    Media LawMergers & AcquisitionsMunicipal Law
    N
    Non-Profit Law
    P
    Patent Preparation and ProsecutionPharmaceutical / Medical Devices / Pharma ServicesProducts and Consumer Liability DefenseProfessional LiabilityPublic Utilities
    R
    Real Estate, Finance, and Land Use
    S
    SecuritiesSolar Energy
    T
    TaxationTelecommunicationsTrademark & Copyright Protection & Enforcement
    V
    Venture Tech & Emerging Growth Companies
    W
    White Collar Investigations & DefenseWorkers’ Compensation
    • New Jersey
    • New York
    • Pennsylvania
    • Blogs
    • Articles
    • Podcasts
    • COVID-19 Resources
    • News
    • Events
    • Webinars
    • About Us
    • Delivering Value
    • Diversity & Inclusion
    • Meritas

    New Jersey

    400 Crossing Boulevard
    8th Floor
    Bridgewater, NJ 08807
    Phone:(908) 722-0700
    Fax:(908) 722-0755

    28 Valley Road
    Suite 1
    Montclair, NJ 07042

    New York

    7 Times Square
    21st Floor
    New York City, NY 10036
    Phone:(212) 808-0700
    Fax:(212) 808-0844

    Pennsylvania

    515 West Hamilton Street
    Suite 502
    Allentown, PA 18101
    Phone:(610) 391-1800
    Fax:(610) 391-1805

    • What sets us apart
    • Attorneys
    • Other Professionals
    • Professional Development
    • Non-Discrimination Policy

    Categories

    Hospitals and Health Systems - Audits and Reimbursement Hospitals and Health Systems - Consent and Treatment Hospitals and Health Systems - Corporate and Governance Hospitals and Health Systems - Corporate Compliance Hospitals and Health Systems - Fraud and Abuse Hospitals and Health Systems - Government Investigations Hospitals and Health Systems - Health Records Hospitals and Health Systems - HIPAA and HITECH Hospitals and Health Systems - Managed Care Hospitals and Health Systems - Medical Staff Issues Hospitals and Health Systems - Medical Training Programs Hospitals and Health Systems - Medicare Hospitals and Health Systems - Mergers, Affiliations and Joint Ventures Hospitals and Health Systems - Peer Review Hospitals and Health Systems - Professional Services Agreements Pharmaceutical Industry - Agreements with Physicians Pharmaceutical Industry - Regulatory Compliance Physicians and Providers - Audits and Reimbursement Physicians and Providers - Certifications Physicians and Providers - Credentialing Physicians and Providers - Disciplinary Actions Physicians and Providers - Employment Agreements Physicians and Providers - Fraud and Abuse Physicians and Providers - Government Investigations Physicians and Providers - HIPAA and Privacy Physicians and Providers - Impairment Physicians and Providers - Licensing Physicians and Providers - Litigation Physicians and Providers - Medicare Physicians and Providers - Peer Review Physicians and Providers - Practice Acquisitions Physicians and Providers - Practice Issues Physicians and Providers - Regulatory Compliance Physicians and Providers - Supervision Physicians and Providers - Training Uncategorized
    Blogs > The Legal Diagnosis > Fighting HMO and Insurance Company...
    Member
    David N. Vozza
    Visit Profile

    Fighting HMO and Insurance Company Terminations

    Fighting HMO and Insurance Company Terminations

    Nothing is more important to the viability of a medical practice than the relationships it enjoys with the patient population that relies on its excellent provision of health care. It is of paramount importance for optimal care that patients trust their physicians and are ensured long-term continuity of care. Of course, physician practices rely heavily on HMO and insurance companies to maintain physicians on practitioner panels and adequately reimburse services rendered. Therefore, when an HMO or insurance company terminates a physician from a panel, it can be devastating for patients and practices alike. Unfortunately, a determination by an HMO or other insurance company to terminate a physician often has nothing to do with the quality of care provided or what is in the patients’ best interests. Rather, these determinations are driven by large corporations looking out for their bottom line.

    Why Do HMOs Terminate Physicians?

    An HMO or other insurance company might terminate a physician for many reasons, including many that have nothing to do with patient care. These include:

    • Disputes over adequate reimbursement rates
    • An arbitrary determination by the HMO that there are too many physicians of a particular specialty in a certain geographic area
    • An arbitrary determination by the HMO that a physician billed incorrectly

    As several corporate giants have come to dominate the health insurance industry in recent years, these HMOs have increasingly terminated physicians from the HMO panels and replaced the terminated practices with HMO-affiliated clinics. This has proven to be bad for physicians and worse for patients.

    What Can Physicians Do?

    Unfortunately, most provider agreements give the HMO or insurance company the right to terminate a physician without any stated reason and with little notice. To mitigate the chances of termination and the resulting damage to a medical practice, physicians are encouraged to do the following:

    • Take whatever legal measures are necessary to challenge a termination in the courts or through arbitration
    • Participate in a wide variety of insurance plans, so that long-term patients have other affordable options
    • Retain health care counsel and certified coders to regularly assess billing and coding practices to prevent insurance audits and disputes
    • Negotiate provider agreements to include provisions that prevent arbitrary terminations

    Contact Norris McLaughlin about Termination from an HMO Network

    Dealing with an HMO termination is scary and stressful, but a health care lawyer can help you through the process of challenging a termination to make the best decision for your practice. If you have any questions about this, or any other legal health care matter, please email me at dnvozza@norris-law.com.

    Member
    David N. Vozza
    Visit Profile

    Related Posts

    Denial of Claims of NJ Medical Practices Based On Contracts With Management Companies in the Aftermath of Allstate

    Share

    Tags

    #HMO #insurance carriers #terminations

    Similar Posts

    May 4, 2020
    New Provider Relief Fund Application Portal Now Open
    New Provider Relief Fund Application Portal Now Open
    September 18, 2018
    Billing Pennsylvania Medicaid for Nursing Facility Residents’ Medicare Part B Copays Ruled as Impermissible Balance Billing
    Billing Pennsylvania Medicaid for Nursing Facility Residents’ Medicare Part B Copays Ruled as Impermissible Balance Billing
    April 25, 2018
    New York State - OMIG Releases its Work Plan for the 2018/2019 Fiscal Year
    New York State - OMIG Releases its Work Plan for the 2018/2019 Fiscal Year

    Helpful links

    • About Us
    • News
    • Services
    • Blogs
    • Attorneys
    • Articles
    • (COVID-19)
    • Events
    • Join our Team
    Connect

    Connect with Us

    • LinkedIn
    • Facebook
    • Twitter
    • Instagram
    • Youtube

    Join our growing team

    We are looking for quality attorneys to help us do more for our clients. At Norris McLaughlin, each attorney has the same opportunity to succeed whether you’re at the beginning of a career or pinnacle of the profession.

    Learn More

    Subscribe to our content

    Receive timely legal information delivered to your inbox

    This field is for validation purposes and should be left unchanged.
    © , Norris McLaughlin, P.A., All Rights Reserved. Attorney Advertising.
    VIEW OUR DISCLAIMER,  TERMS OF USE,  AND PRIVACY POLICY

    We use cookies to ensure that we give you the best experience on our website. If you continue to use this site we will assume you consent to our cookie policy. Learn more