Managed health care Essay Example | Topics and Well Written Essays - 500 words - 4

Managed health care - Essay Example The patient’s confidentiality must be protected by the provider. A provider is liable for breach of patient’s confidentiality if they disclose confidential information related to the patient without their consent as required by the law (Roberts, 2000). When a managed care organization asks for the client’s personal information to make payment decisions, it may undermine the confidentiality of the patient (Wellspring Counseling, 2005). Providers should be careful in limiting the ability of the managed care organization to modify or amend the contract on its own. If it is possible, the provider is supposed to negotiate the amendment provision, which necessitates the consent of the concerned parties before any amendment is done (Roberts, 2000). Majority of the managed care contracts possess dispute resolution clauses. These clauses deal with the manner in which disputes associated with the agreement will be resolved by the entities. The dispute resolution process includes mediation, arbitration, and litigation in court (Roberts, 2000). The contract must indicate that the provider is not mandated to offer, â€Å"any services under the contract that it does not ordinarily and customarily provide to its patients who are not members of the contracting MCO and its affiliate plans† (Ziel, 1997). The concerned entities may consider adding a clause that particularly lists all the services provided by the MCO and the plans (Ziel, 1997). One of the key issues in quality assurance and utilization management is that providers can be subjected by the managed care organizations to utilization management procedures and policies, which are administered inconsistently and unjustly. There are cases where the providers are not even offered the copies of the policies (Roberts, 2000). A provider is supposed to think about its mandates under the agreement before the contract is