The healthcare industry is a complex world regulated by strict rules and controls that simultaneously protect patients and healthcare providers. One of the core aspects of the field is healthcare agreements that serve as the foundation of medical care. However, these agreements are not merely transactions but binding legal documents. This article explores the legal considerations in healthcare agreements, specifically how patients and healthcare providers should remain compliant.  

Understanding Healthcare Agreements

Legal jargon is often difficult to understand, no matter who you are, where you come from, or what medical condition you may have. For this reason, seeking assistance to understand healthcare agreements and highlighting the points on which you need further guidance is imperative. Here are some aspects of a healthcare agreement. 

• Consent is key: Before doctors can start treatments, patients must sign a consent form that confirms they understand the procedure in its entirety, including the benefits and risks involved. 
• Content of treatment plan and agreement: Patients have the right to be informed and educated about their treatment plan, including its scope and associated costs. 
• Financial agreements: Finances are often the most sensitive topic when discussing patient care. Agreements must detail the scope of treatment and include every cost associated with it, as well as the payer’s responsibilities.
• Confidentiality agreement: In recent years, privacy has been at the forefront of patient satisfaction, and thus, confidentiality and a patient’s right to privacy have been protected through agreements.  

Types of Healthcare Agreements

There are many types of agreements to consider; however, here are a few common examples to be aware of:

• Single case agreements: A single case agreement is a contract between an insurance company and an out-of-network provider. These are often unique and entail a patient receiving specific treatment for a set period with an agreed-upon rate.  
• Provider-patient agreements: This contract details the terms of the relationship between medical professional and patient. The contract includes the scope of services, payment arrangements, and patient responsibilities. 
• Managed care contracts: Managed care organizations are concerned with finding healthcare providers to treat their members. These contracts contain strict guidelines on how the members should be cared for, detailed payment and reimbursement descriptions, and the expected quality of care. Medical professionals are required to always adhere to this contract. 
• Insurance agreements: These are often the most common agreements. They include benefits, premiums, and patient coverage. Patients with insurance agreements must understand the agreement thoroughly to avoid treatment delays or out-of-pocket expenses. 
• Partnership agreements: These agreements are less common, but they do occur. They involve a medical professional entering into a deal with a clinic or hospital and collaborating on patient treatment.  

Legal Compliance

Regulatory compliance is essential as it protects the medical professional and the patient. Furthermore, legal compliance ensures rights are protected, and the correct care is provided. Here are some key considerations:

• Regulatory compliance: Understanding the Health Insurance Portability and Accountability Act is one of the best ways to remain compliant with local, state, and federal laws. 
• Informed consent: As stated previously, medical professionals are obligated to detail the treatment plan in an easy-to-understand manner to each patient. This allows the patient to make an informed decision regarding their treatment. 
• Transparency: Patients must understand their agreements, so they must be written in easy-to-understand language and remain transparent with little to no medical jargon unless necessary. Ambiguous language can lead to misunderstanding. 
• Competence: Doctors must evaluate a patient’s competence before they sign an agreement. Patients must be of sound mind when signing and agreeing to treatment. 
• Ethical practices: Healthcare providers follow a strict code of conduct that includes fair and ethical practices for their patients. Medical professionals must uphold these ethical practices by avoiding discrimination and exploitation.  

Protecting the Rights of Patients

It comes as no surprise that healthcare agreements are essential to protect patients and promote patient-centered care. There are a few strategies medical professionals should consider to ensure patients’ needs are met while simultaneously remaining compliant.

• Educating patients: Without a level of patronization, educating your patients on their conditions and treatment plans empowers them to make informed decisions. This protects you as the doctor and the patient.
• Record keeping: Several digital tools allow you to track patient information accurately. Ensure you have documented agreements, consent forms, and treatment plans to ensure compliance and transparency. 
• Review agreements: Occasionally, review agreements and update terms where necessary. It is recommended that agreements be reviewed at least twice yearly when regulation is updated. 
• Communication: Be transparent and communicate changes in agreements timeously to build trust with the patient. 
• Legal counsel: Ensure you have legal counsel for patients unsatisfied with an agreement or treatment.  

Remaining Legally Compliant Is the Key

Healthcare agreements are more than documents that outline patient care. It involves clear guidance on payment and treatment and governs the interaction between patient and doctor. For this reason, patients and medical professionals need to remain compliant and ensure they understand agreements before signing them.

Disclaimer: “The content in this article is provided for general knowledge. It does not constitute legal advice, and readers should seek advice from qualified legal professionals regarding particular cases or situations.”

Published by: Nelly Chavez