The practice of psychiatry as with the practice of medicine in general has changed dramatically in the last fifteen years. The words “managed care,” “provider network” and “individual case management” are familiar to anyone who has ever cracked their employee benefits manual. Gone are the days when the patient selected a physician or psychiatrist and submitted invoices to the insurer. Now, when a patient needs care the first thought is to check to see which providers are part of her network.
Independent providers, not affiliated with a network, are the rarest of things for the simple reason that the insurers will not approve payment for their services. The concept of “managed care” is not Protecting Patient Privacy without its benefits, and it is not the purpose of this lawsuit to impugn the concept. However, managed care adds a third party administrator into the doctor/patient equation, and vigilance is required to protect this time honored and statutorily protected relationship.
The primary issue in this case is whether was properly terminated for refusing to comply with the request to review five treatment records. Contends that this refusal to comply with this request can lead to his termination only if the request was in accordance with all laws, regulations and the Ponemon Cost of a Data Breach standard of care.
Not only did the judge order reinstatement as a participating provider, he ordered the defendants to inform every patient that they had told of the psychiatrist’s decredentialing that he had in fact been reintate4d. The judge added another condition as well, namely, that the managed care companies conduct a thorough internal administrative review of the way in which they applied their decredentialing procedures in this case.