Raja Sékaran Quoted on In-Network Physician Group Participation with Hospitals

01.12.2019
Modern Healthcare

Healthcare Partner Raja Sékaran was quoted in the Modern Healthcare article, Hospitals' Solution to Surprise Out-of-Network Bills: Make Physicians Go In-Network.  The article examines the unusual, but potentially beneficial, practice of requiring in-hospital physician groups to contract with the same insurers as the facilities in which they work as a means of preventing exorbitant out-of-network medical bills for patients.

Once a common practice, Raja points out that as [t]he medical groups in general have grown … they've added other professionals to support them in their business and have asserted themselves more than they have in the past.  The article points out that this has increasingly led to physician groups simply not contracting with the same health plans and insurers as the hospitals in which they work. 

Raja explains that while this ability to negotiate with health plans and insurers has led to greater bargaining strength for physician groups, it can cause problems for patients.  He suggested that health systems inform their patients that their healthcare services could be more expensive if they use a physician group that doesn’t contract with the hospital’s insurance provider, but he warned against identifying the out-of-network physician groups by name. 

In general, one doesn't want to make representations about other people's business relationships, especially if they're subject to change, Raja said.  That could generate some civil liability.

For the full Modern Healthcare article, click here.

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