Providers treating patients enrolled in limited benefit plans need to be able to identify these products and plan to ensure that they do not get caught between abandoning a patient and treating him or her without compensation. The following is a tip to make these arrangements work for both you and your patients.
Check your payer agreements. Look at the terms of your existing payer agreements to see whether they permit individuals enrolled in these types of plans to be included. Ask yourself the following questions:
Do your payer agreements limit the products that you will accept? How is the limit defined?
What notice is a payer required to give you before launching a new product? Ideally, your contract will require a payer to give you details about the product as well as 45 or more days advance notice or a new product design to evaluate it.
How do your payer agreements define new products? Does the definition clearly include limited benefit design products?
If you are notified of a new product, what rights do you have to review the product and negotiate additional terms related to it?
Can you opt out of new products?