Some advice before you sign: AMA Model Managed Care Contract

Before you sign on the dotted line with a health plan, check out the AMA's updated model contract.

Editorial. March 1, 2004.

For the many thousands of physicians now involved in contracts with managed care organizations, the problem needs little explanation. Put a group of physicians together in almost any environment and the conversation inevitably turns to a sharing of frustrations, angers and resentments carried by some practitioners toward managed care.

Recognizing the needs -- and problems -- of these physicians, the American Medical Association has just published an updated version of the AMA Model Managed Care Contract to reflect legal and other developments since the first edition was published several years ago. New portions of the model contract -- now in its third edition -- address developments in the law regarding medical necessity, HIPAA regulations and prompt payment -- three of the biggest issues that cause headaches for physicians.

Also a part of the new AMA package, developed by the Association's Private Sector Advocacy unit, is "15 Questions to Ask Before Signing a Managed Care Contract." The two-page pamphlet, written in clear, straightforward prose, provides a valuable, comprehensive checklist for any physician contemplating entering into a new agreement. A sample:

Q: How do you determine whether medically necessary services are covered by a patient's benefit plan?