Avoiding Ethical Issues in Meeting Contract Requirements, Research Paper Example

A number of ethical issues arise during the treatment of patients and the fulfillment of contractual requirements. Since physicians, nurses, and other care staff are at the center of the patient relationship, they are often also at the center of many ethical issues and disagreements. Ethical issues come about when negotiating a contract with a managed health care firm, implementing the contract, informing the patient of the managed care decision, and when acting as an advocate for the patient. (ArcMesa Educators, 2012) Some examples of ethical issues include having to address the patient’s need for treatment after preauthorization for payment is denied, justifying the use of out-of-network services, and obtaining payment for claims wrongfully denied by the insurance company. (ArcMesa Educators, 2012)

There are some things care providers can do to help avoid ethical issues in meeting contractual requirements. One is to negotiate using the concept of good faith, an umbrella term for guiding principles that represent the philosophy and ethics of the individual or corporation and allow all parties to follow their professional code of ethics. (ArcMesa Educators, 2012) If there are doubts about an individual or company being contracted with, then it should be seen to that the contract is written as detailed as possible and all verbal agreements are put into writing. Another defense that can be used is the Rotary Four-Way Test, a test developed by Rotary International to help determine if actions in a business situation are ethical. (Rotary International, 2012) There are four medical ethical principles that can be applied when negotiating: respect for persons, beneficience, nonmaleficience, and justice. These can be applied using the Rotary Four-Way Test. (ArcMesa Educators, 2012) When working under the contract confidentiality should always be maintained, the care provider should always have access to the decision-making authority, and accurate data and figures should be provided by all parties to avoid any misunderstandings and make clear all positions and motives.  

References

ArcMesa Educators. (2012). Ethics in Managed Care Contracting. Retrieved August 8, 2012, from Nursing Link: http://nursinglink.monster.com/training/articles/328-ethics-in-managed-care-contracting

Rotary International. (2012). Guiding Principles. Retrieved August 8, 2012, from Rotary International: The Rotary Foundation: http://www.rotary.org/en/aboutus/rotaryinternational/guidingprinciples/Pages/ridefault.aspx