Provider contract with MA/MAPD

[JJ2713]

How do the contracts work between doctors and other providers and MA/MAPD plans?

Does the contract last for a specific term and then must be renewed by each party?
Is the contract open-ended and indefinite?

I know doctors can leave the network.

Doctors should be contracted for the calendar year so there are no changes in network providers, so clients don't get screwed over by thinking their doctor is in their MAPD network for the year and then isn't.

 

[MedicareMillionair]

Typically the contract corresponds with the Plan year. I'm not sure of the exact inner workings of contracts, but they typically role over into the next calendar year unless one of the parties desires renegotiation. The renegotiation will correspond with calendar plan year.

I have a friend that handles contract negotiation for one of the top three health insurers. It's very interesting to get the inside scoop. For example, hospital groups are likely to negotiate that a competing hospital group NOT be available in the network. In return they would allow for a lower fee schedule. Even so far as refusing very large corporate contracts if they weren't "preferred". Lots of backroom politics being played in these negotiations.

There was a very popular Dr in a network local to me that was terminated from a plan, mid year, for cause. The Dr told all his patients that he refused to do business with the company any longer, due to the insurance companies incompetence and suggested his clients switch to another plan so they could maintain access to his office. While he was bad mouthing the company, he was also appealing his termination with the company. In essence, asking for another chance to remain in the companies network of providers.

The end result was the perception that the company was the reason for this chaos. Actually it was the Dr. Most of us will never know why these sudden changes happen, but you can bet there is a good reason in the background.