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Policy Compendium

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MAN-014: Disclosure of Incentives and Restrictions on Care in Managed Health Systems

 
Disclosure of Incentives and Restrictions on Care in Managed Health Systems: The Wisconsin Medical Society supports full disclosure of incentives and restrictions on care and recognizes that there may be conflicts between health care payment mechanisms and the provision of medical services. The Society believes that restrictions and limitations to care in all health plans should be disclosed clearly and completely in the patient/plan contract and in promotional materials.

Examples of disclosure include but are not limited to:

  • The role of a primary care physician should be explained fully, along with any specialty referral requirements stating a primary care professional must approve the services in advance.
  • If there are restrictions on which physicians may be seen, these should be explained.
  • The procedures should be complete and understandable.
  • Restrictions for obtaining emergency services should be explained at the time of signing the contract. (HOD, 0414)