Arbitration: Should You Treat HMO Patients Who Decline?

CAP Members who offer their patients arbitration agreements consistently report overwhelming acceptance by their new and continuing patients. Even those physicians, initially hesitant to inject the specter of legal action into their new patient relationships, soon find that the contracts quickly become a non-issue.

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But, physicians who refuse to see patients who decline arbitration may find that they have some other contracts that come into play. The following is a good illustration:

Dr. F is a family practitioner and a long-time user of arbitration agreements with his patients. One day, Dr. F received a certified letter from the medical director of a managed care company with whom Dr. F had contracted. The letter summarized a complaint from a participant in the plan.

The participant had a first-time appointment with Dr. F. Upon arrival, the gentleman was given an arbitration agreement to review and sign. The participant declined to sign the agreement and asked Dr. F’s staff if he could be seen by the doctor. After a 45-minute wait, according to the participant’s complaint, he was put into a room and then finally seen by Dr. F. When Dr. F and the participant discussed the arbitration agreement, the gentleman told Dr. F that he was not required to sign it. Then, according to the complaint, Dr. F told the participant that he would not see him.

The letter from the medical director asked Dr. F for a “written summary addressing the issues noted in the complaint, specifically: The refusal to see patients who choose not to sign an arbitration agreement.”

The contract that Dr. F had with the managed care company made no reference whatsoever to physician-patient arbitration agreements. In his discussions with the managed care company regarding the complaint, the company cited the terms of the agreement calling for Dr. F to “make available and render as appropriate health care services or benefits to beneficiaries or claimants which [he] is qualified by law to provide . . . .”

What Dr. F had relied on, however, was a section of the contract that said that he would “provide prompt availability and accessibility of health care services or benefits to beneficiaries or claimants in the same manner and quality as to all other patients.” Dr. F explained that he required all of his patients to sign arbitration agreements.

Given that the arbitration issue had not been specifically addressed in the contract, Dr. F advised the managed care company that he would continue to offer new patients arbitration agreements and would attempt to persuade them to sign. Nevertheless, he told the company, he would treat patients who decline to sign the arbitration agreement.

As a program, physician-patient arbitration provides significant savings to CAP-MPT Members because of the dramatic savings in legal fees necessary to defend medical liability disputes. At the individual physician level, arbitration can shave days and weeks off the time necessary to attend such hearings. Given the overwhelming number of patients who agree to arbitration without question, physicians can achieve both of these benefits without turning away patients who decline to sign.

In any event, physicians should contact their managed care organizations if they have any questions about offering their patients the arbitration option.

Gordon Ownby, CAP-MPT’s general counsel, can be reached at gownby@cap-mpt.com.