Issue Background

Fair Contracting and Medical Practice Freedom

Where We Stand

  • Ensure openness and fairness in health care provider contacts. 
  • Prevent third-party payors from changing the terms of their provider contract without notice to the provider and without the consent of the provider.
  • Ensure that physician licensure is based upon a physician's education, training, experience and competence and not socioeconomic objectives.
  • Prevent states from conditioning physician licensure upon participation in any public or private third-party payor program.
  • Improve the practice environment for physicians in your state.

As professionals, physicians should expect to be treated openly and fairly by those with whom they transact business. This includes being given sufficient notice of any changes an insurer seeks to make to its provider contracts, the opportunity to either accept or reject those changes and the assurance that the rejection of any proposed changes will not adversely affect their relationship with the insurer. Legislation is needed to effectuate these principles.

Physicians should not be coerced into participating in third-party public or private payer systems. Nevertheless, for years states have attempted to condition professional licensure on participation in such systems. With the expansion of Medicaid and the establishment of new insurance exchange systems, state politicians may feel even more pressure to require physician participation in certain third-party public or private payer systems. Legislation is needed to prevent conditioning medical licensure on participation in third-party public or private payer systems.