No good deed goes unpunished in managed care contracting

It's been said that "no good deed goes unpunished." This is certainly true when it comes to negotiating with managed care companies, as I've learned the hard way. Little did I know; a contract that is never signed can still become binding if one party can prove that what actually happens in the relationship between the two parties demonstrates a meeting of the minds.

Many payer agreements have passed my desk during my career in managed care and healthcare administration. As a beginner, I thought that if we didn't sign the contract, we weren't bound by its terms. In one case, more than 15 years ago, a physician with whom I worked decided that he would refuse to sign the contract draft agreement.

What he did instead was to act "as if" we had a contract with the payer: We accepted their rates, wrote off balances in excess of the allowable, and charged co-payments to the patients.

When records requests were received to substantiate and defend the treatment rendered, we complied without requesting payment for medical records copies. When the plan failed to pay secondary using the excuse that the primary paid what they would have paid, so that no additional payment would be tendered, we wrote off the balance. When a remittance summary contained a denial due to lack of pre-authorization, or pre-certification and a there was failure to obtain a non-covered waiver, we wrote off the balance owed. We did everything we could to be a good citizen--except sign the contract.


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