UHC United Healthcare requiring NDA before signing on as provider, anybody familiar with this!

[SJellyModo]

Hi has anyone when credentialling as a provider with an insurance company been asked to sign a blanket NDA to cover "rate fees" and "contractual terms" so as to become enrolled in the provider network? This seems a violation of some law, Stark Law or pushing a physician to practice medicine in the payer's best interest or practicing medicine as business vs. clinical best interest.
I would like to post the NDA for your review but some blip in the footer says I can't.
HIPAA pretty much covers everything in regard to protecting medical information.
Upon review of UHC they are undergoing a major federal whistle blower investigation for medicare/medicaid fraud. In California, a number of provider groups have filed lawsuits for nonpayment of claims.
In general, NDAs are typically written into the contract that you are signing, saying you will not disclose confidential items of the business, but you actually see the terms of contract and items NDA covers. Its unusual to be served an NDA before being allowed to see the actual contract though.

---

Members don't see this ad.

 

[DocVapor]

Hi has anyone when credentialling as a provider with an insurance company been asked to sign a blanket NDA to cover "rate fees" and "contractual terms" so as to become enrolled in the provider network? This seems a violation of some law, Stark Law or pushing a physician to practice medicine in the payer's best interest or practicing medicine as business vs. clinical best interest.
I would like to post the NDA for your review but some blip in the footer says I can't.
HIPAA pretty much covers everything in regard to protecting medical information, where could I alert/whistle blow this activity by UHC, so someone could review this activity.

You should consult an actual lawyer.

 

[dieABRdie]

Hi has anyone when credentialling as a provider with an insurance company been asked to sign a blanket NDA to cover "rate fees" and "contractual terms" so as to become enrolled in the provider network? This seems a violation of some law, Stark Law or pushing a physician to practice medicine in the payer's best interest or practicing medicine as business vs. clinical best interest.
I would like to post the NDA for your review but some blip in the footer says I can't.
HIPAA pretty much covers everything in regard to protecting medical information, where could I alert/whistle blow this activity by UHC, so someone could review this activity.

UHC United has quickly become the worst payor in terms of trying to deny as much care as possible. They are denying every little thing they can. We've been holding firm with our recommendations, but every patient gets delayed starting treatment by at least a week. Its not really an effort to actually deny the treatment... but to test the waters to see what else they can get away with.

I'm sure this is a similar tactic. I imagine this is an effort to control your communications with them.... with the end goal of keeping you from disclosing what is effectively "corporate malpractice of medicine". I have been recording the peer 2 peers. I'm sure others are too. If you have signed a non-disclosure agreement... they will try (or at least threaten) to file suit if you publicize what transpired. Even if the patient wants the information to be recorded and publicized...

I must disclose this is my presumption and I am not a lawyer. But, as someone who interacts with them frequently.... I would not put it past them.

Absolutely get a lawyer's opinion.

 

[SJellyModo]

On another note, just want everyone to be aware, that it is against HIPAA to require a provider to accept VCC payment as the only form of payment and that ach must be offered. The payers are really pushing VCC, even workers comp to collect on a value service fee, essentially a chargeback.

There is a helpful article by AMA that can guide you on how to motivate payers to activate Ach Direct Deposit, which should take less than 1 month to become effective. https://www.ama-assn.org/system/files/vcc-eft-cms-guidance.pdf

Optum Pay which handles the payment for UHC, gave me the run around for 3-4 months, losing records of calls, requiring resubmission of same paperwork, 6-8 phone calls, hanging ups when redirection to complaints department requested, and a formal filing of complaint to get them to enroll me in direct deposit. They make it a very difficult process to get enrolled in a simple DD when trying to opt out of VCC, I would actually submit a copy of your ASETT complaint when initialing enrolling for ACH so you don't get the mock run around.

 

[SJellyModo]

UHC United has quickly become the worst payor in terms of trying to deny as much care as possible. They are denying every little thing they can. We've been holding firm with our recommendations, but every patient gets delayed starting treatment by at least a week. Its not really an effort to actually deny the treatment... but to test the waters to see what else they can get away with.

I'm sure this is a similar tactic. I imagine this is an effort to control your communications with them.... with the end goal of keeping you from disclosing what is effectively "corporate malpractice of medicine". I have been recording the peer 2 peers. I'm sure others are too. If you have signed a non-disclosure agreement... they will try (or at least threaten) to file suit if you publicize what transpired. Even if the patient wants the information to be recorded and publicized...

I must disclose this is my presumption and I am not a lawyer. But, as someone who interacts with them frequently.... I would not put it past them.

Absolutely get a lawyer's opinion.

Agree with lawyer, but really like to learn about others experience and handling with insurers like UHC. As an individual provider can just not enroll or not accept that insurance.

 

[nimbus]

Agree with lawyer, but really like to learn about others experience and handling with insurers like UHC. As an individual provider can just not enroll or not accept that insurance.

That’s hard to do when they have the largest market share in the US.