CMA offers members free access to objective analyses of several health plan participating provider contracts. While these analyses are not intended to be exhaustive, they are designed to draw a physician's attention to issues which may warrant further inquiry or clarification.
NOTE: CMA is currently updating contract analyses for each of the major health plans in California. These analyses will be posted on the website when they are available. In the meantime, if you have any questions regarding specific health plans contact CMA’s reimbursement help line at (888) 401-5911 or economicservices@cmanet.org.
- Anthem Blue Cross of California Prudent Buyer Plan
- Blue Shield
- Health Net
- United Healthcare Contract Analysis, January 2007
CAUTION:
The analysis notes the specific version of the contract to which it applies. Physicians with a different version of the contract must not assume that their contract is the same.
As a reminder, CMA cannot make recommendations as to whether a physician should sign a particular contract, or whether a specific contract is good or bad. However, CMA does recommend that physicians fully and intelligently understand the vast range of legal and practical implications associated with the execution of any contract for the delivery of medical services or the associated management and administrative services. For additional information on how to evaluate and negotiate complex managed care contracts, see CMA’s contracting toolkit, Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations - A Focus on Payor Contracting.
Because of the antitrust laws, independently competing physicians should not collectively decide whether, or on what terms, to sign contracts. Such group activity could be considered a "group boycott" in violation of the antitrust laws. To avoid a group boycott challenge, physicians should avoid sharing these analyses and deciding how to proceed with respect to the contract with competing physicians. (Note that the antitrust laws do not prohibit physicians from deciding with members of their own group practice on how to proceed). For more information on the antitrust laws, see ON-CALL document #0210, "The Antitrust Laws: What Physicians Can Do."
Unfortunately, we are unable to give specific legal advice to every physician and medical group that utilizes the contract analysis service. Physicians who are interested in personal legal advice and representation with respect to this contract or other physician business matters should contact their personal attorneys, or may contact the law firm that provides CMA's contract analysis service. For more information on CMA's contract analysis service and the discounts available to CMA members, see ON-CALL document #1705, "CMA Contract Analysis Service."
Please note: CMA currently contracts with the law firm of Bond, Gamma & Associates, 821 Bancroft Way, Berkeley, CA 94710-2226, 510-841-7500.