Negotiate Out Referral Requirement in Managed Care Contracts

When negotiating a managed care contract, again think about those day to day managed care administrative duties that if removed, would make your practice life much, much easier.

One of these duties is the one where specialists must obtain a “referral” or “authorization” from the managed care plan in order to further treat a patient (surgery, hospital admission, MRI, etc.) If the managed care plan has never in the past DENIED referral or authorization for your practice, then why must you keep on doing this time-hogging task????

So if you are a specialist medical practice, try to get this process removed when you are negotiating your physician managed care contracts. Your stance should be that why do you have do to this when in fact the managed care plan never denied care in the past?????  It is just a piece of red tape that shouldn’t be there.