Orlberg Agreement, Essay Example

Under section 2.2, the contract states that Orlberg will agree to provide covered services to participants. My concern with this is that it does not state in this section that Orlberg will provide non-covered services at the participants’ expense. I do not believe that the contract should state that health care will be denied due to lack of coverage.

Another key concern comes from section 2.10.3. The contract states that the payor’s obligation to remit payment will be waived for each day where the patient’s stay is as of a result from the unavailability of operating or procedure room space, rescheduling, inadequate nursing procedures and suboptimal planning. While this is a strong practice for the benefit of the patient, it does not state which party involved will be responsible for the costs of these expenses. This opens up room for interpretation and could cause issues in the future.

Furthermore, section 3.4 and is concerning that Anthem has the right to influence a participant’s choice of Participating Provider. Finally, section 4.3.1 also holds additional concern to 2.10.3 stating that the Participant shall not be billed by Orlberg for the hospital’s failures. This questions who should be held liable.

Bibliography

Medical liability reform. (2007). Retrieved from http://www.atra.org/show/7338

Patient liability after insurance. (2012). Retrieved from Dukehealth.org. (n.d.). Retrieved from http://www.dukehealth.org/patients_and_visitors/patient_billing/patient_liability_after_insurance