title: Health plan payments to noncontracted providers.
abstract: A recent legal trend involves the resolution of disputes between health plans and nonparticipating providers. These individuals have not entered into a formal participation or services agreement with the health plan, but they may be eligible for and legally entitled to reimbursement for services rendered to plan participants. Resolution of these disputes can hinge on a number of factors, including benefit design, state law, and patient compliance with administrative requirements.
authors.affiliation: Pecor & Doherty, LLC, Columbia, Maryland 21045, USA. jdoherty@pecoredoherty.com
authors.forename: James F
authors.initials: JF
authors.lastname: Doherty
mesh_terms: D032982:Contracts; D003695:Delivery of Health Care; D006297:Health Services Accessibility; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration*; D012051:Reimbursement Mechanisms / Q000331:legislation & jurisprudence*; D014481:United States