Medical Retainer Agreements

Concierge medical practices must comply with supplier participation agreements and other third-party payers` rules. For example, most participation agreements generally require providers to accept payments for services covered by the insurance company as a “full payment” and cannot require “any kind” advances from patients. In addition, providers can only require patient payment for deductibles, supplements and services not covered. In 2015, Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) updated their concierge practice policies to provide guidance to Michigan health care providers. The Blue Cross Directive provides that providers who wish to apply concierge or retainer practices must ensure that models are permitted in supplier partnership contracts and that suppliers may charge a concierge fee as long as (i) members are not required to pay the concierge fee to become or remain a patient in practice; (ii) members are not required to pay the janitor`s fee to access the provider and may only have access to auxiliary providers such as medical assistants or nurses if they do not pay the fee; (iii) the services or products offered are not classified as “covered services” under the reference agreements, but are not covered by the members` performance plan; (iv) providers maintain access and services to patients who have not paid the fee and continue to meet BCBSM and NCB access standards; and (v) concierge service is well above current practice in Michigan. Blue Cross also anticipates that complaints that patients have experienced a deterioration in the level of service as a result of a provider`s transition to a concierge practice may lead Blue Cross to conclude that the practice is contrary to the non-discrimination provisions of the membership agreement. In addition, participating providers and patients enrolled in health care organizations (HMOs) may face increased restrictions on medical concierge agreements. Because of these requirements, providers must carefully structure janitorial practices and structure transitions to janitorial medicine so as not to discriminate against existing patients who choose not to enter into a concierge contract. Historically, Michigan janitorial medicine has been hampered by the state`s insurance code, as agreements between providers and patients could fall within the definition of insurance traps and, as a result, require providers to adhere to complex health insurance rules. In 2015, Michigan passed Public Law 522, The Law defines a medical retention contract as a contract between a physician and a patient or its legal representative, in which the health care provider agrees to provide each patient with routine health care for a specified fee and period.2 child care contract under the law , the agreement (i) must be written; (ii) are signed by the health care provider`s doctor or agent and the patient or legal representative; (iii) allow any party to denounce the agreement in writing to the other party; (iv) the description and quantification of the specific routine health services contained in the agreement; v) set the contractual tax; (vi) setting the deadline as part of the agreement; (vi) declare in writing that the agreement is not health insurance; (vii) prohibit the health care provider and patient from charging an insurer or other third party for services provided under the agreement; and (viii) in writing, that the patient must pay the provider for all services that are not listed in the agreement and are not covered by any other insurance.3 Provided that janitorial practices and patients enter into claims contracts and otherwise meet legal requirements, janitorial practices are not in the verse