The need of an individual for
emergency treatment in cases of acci- dent or sudden illness may, as a prac- tical matter, preclude free choice of a physician, particularly where there is loss of consciousness.
Although the concept of free
choice assures that an individual can generally choose a physician, likewise a physician may decline to accept that individual as a patient. In selecting the physician of choice, the patient may sometimes be obliged to pay for medical services which might other- wise be paid by a third party. (VI)
If you have a contract with an insur-
er to provide services to those covered under the insurance plan, you may not withhold services from or directly bill the patient during the grace period. In addition to the federal regulation that anticipates patients will be treated as ful- ly covered until the grace period expires, many insurance company contracts have nondiscrimination clauses that prevent the withholding of services. Here is an example of a nondiscrimi- nation clause:
Physician and Insurance Company agree that enrollees expect physicians listed in the Company’s directories to accept new patients. Physician shall provide services to Enrollees on the same basis as other patients. Physi- cian shall accept Insurance Company Enrollees as patients.
This example imposes an obligation that affects duties under the patient- physician relationship. In regard to the grace period, it is possible to interpret the phrase to accept patients “on the same basis as other patients” means that care cannot be withheld when the pa- tient is considered covered by the insur- er. Indeed, the example above expressly permits the insurer to list the physician as accepting new patients.
The last sentence of the example gives the physician no flexibility in ac- cepting patients. He or she must accept all enrollees as patients, even if the pa- tients are in exchange plans or if the physician previously terminated the re-
LeichterTxMedAdV3-3-2013-O.indd 1 L AW FIRM PC
8/6/13 1:46 PM February 2014 TEXAS MEDICINE 9
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