All-Products Contracts

Managed care plans cannot sell policies without having a sufficient number and variety of physicians under contract to meet the needs of subscribers. While developing this network the provider really has leverage, as the plan cannot go to market with a certificate of authority until it can prove to regulators that it has an appropriate group of credentialed physicians and other health care providers sufficient to meet the need of its subscribers in the network. Without this group of providers empanelled, it would be difficult for the plan to require the use of the in-network (INET) provider roster in order to access prenegotiated discounts and create a disincentive to avoid the use of out-of-network (ONET) providers who have not agreed by contract to uphold health plan utilization and quality parameters and performance requirements. Once a network is in place, the only real leverage or power an individual physician or hospital may have in negotiations with a managed care company is the power to say “no” to contract terms that are unacceptable for clinical, financial, or other market-driven reasons. The insurance and payer industries recognize this power and have begun to implement and enforce “all-products” clauses, a controversial technique to limit providers’ ability to pick and choose whether to participate in the many types of plans each company offers.