How an employer can negotiate with a medical provider to avoid malpractice liability

If you contract with a medical provider, negotiate concerning malpractice liability:

• A contract between an employer, managed care organization and provider should clearly state who determines medical necessity.

• A contract should describe appeals procedures.

• A contract should include quality of care disclaimers.

• Benefit plan documents, employer handbooks and other communication material should clearly convey plan responsibilities, which services are covered, and appeals procedures.

• Providers in network should be quality providers, qualifications of personnel should be checked, and physicians should actively practice in the area in which they review cases.

• Written materials should state that responsibility for determining appropriate care is with employees and physicians.

• Handbooks should explain that the health plan only determines what will be paid for, not whether employees will receive care.

• If the employer offers several plans, employees should sign statements that they understand the plan they have selected and the implications of the plan.

• Risk-sharing payment arrangements should be constructed so they do not discourage providers from practicing good medicine.

• Employers should incorporate hold-harmless agreements into contracts with providers.

• Employers should amend general liability policies to cover more than incidental medical malpractice or purchase separate vicarious liability coverage for contingent exposures.