Practice Income and Managed Care

Physician's Money Digest, March31 2005, Volume 12, Issue 6

Many doctors find managed care a bit confusing and are unsure if membership in a managed care network will help or hinder their practice. You may find that some managed care companies require you to pay a network-processing fee. It's a rare occurrence, but you should check into the network further before laying down your money.

First, you must know whom you are considering. What is a managed care company? Most say it is a company that contracts to provide health care services to a defined population, but some will have other definitions, so it is important to find out. Fees may range from $95 to $140. Before you pay, get answers to the following questions:

- Does the company actually hold managed care contracts itself, or is it a clearinghouse that creates lists of providers and then passes them on to other companies?

- How many subscribers is the company covering in your area? Can they quote you a figure for behavioral health care specifically, or just give you figures for general medical care?

- How many physicians on their panel actually receive referrals from the network?

- Can you speak to other physicians in your area who have already signed up? Will the company give you contact names and numbers?

- Will the company give you a refund if you are not satisfied? Is there a time limit or special procedure to go through before you can get your money back?

Source: Practice Builders; 800-679-1200; www.practicebuilders.com