Here’s A Provider Contract That Will Lower Your Health Care Costs By +50%

You are a third party beneficiary to provider contracts someone else you’ve never met negotiated. You have no clue what you have agreed to pay for care………… and no one tells you…… until you pay for care.

Your group health insurance costs go up double digits every year, year after year. You think there is nothing you can do to bring health care costs down because your broker thinks the same. You are mistaken………….and so is your broker. (Read on, it gets better)……

The following provider agreements will solve your problem. The sample agreements shown below pay providers the same as what the government pays on behalf of millions of people and which is accepted by 98% of all living providers on your part of the planet. Dead providers no longer accept them but 98% or more of their future replacements undoubtably will.

Some providers want more. That’s Ok. Fill in the blank with the appropriate % of Medicare both sides can agree to and you’re good to go. Some clients have Agreements at 100% of Medicare but most are 130% with a few at 150% of Medicare.

These Agreements are simple. Why complicate simple things. That’s silly.

Feel free to use these Agreements. All you have to do is delete MedSave Management LLC and enter your company name.

HOSPITAL PROVIDER AGREEMENT

Between MedSave Management LLC and [Hospital Name]

This Hospital Provider Agreement (“Agreement”) is entered into as of [Effective Date], by and between MedSave Management LLC, with offices at [Business Address] (“Company”), and [Hospital Name], a licensed hospital with offices at [Hospital Address] (“Hospital”).

1. DEFINITIONS

  • 1.1 Covered Services Inpatient and outpatient hospital services provided by Hospital that are medically necessary and covered under benefit plans administered by Company.
  • 1.2 Medicare Rate The applicable Medicare Prospective Payment System (PPS) rate as published by the Centers for Medicare and Medicaid Services (CMS), including but not limited to DRG, APC, or other applicable Medicare payment methodology.
  • 1.3 Members Individuals enrolled in a health benefit plan for which Company provides administrative or network services.

2. TERM AND TERMINATION

2.1 Term: This Agreement shall remain in effect for a period of one (1) year from the Effective Date and shall automatically renew for successive one (1) year terms unless terminated by either party upon sixty (60) days’ prior written notice.

2.2 Termination for Cause: Either party may terminate this Agreement upon thirty (30) days’ written notice for material breach not cured within the notice period.

3. HOSPITAL OBLIGATIONS

  • 3.1 Services: Hospital shall provide Covered Services to Members in accordance with all applicable federal, state, and local laws and regulations.
  • 3.2 Licensure and Accreditation: Hospital shall maintain all required licenses and accreditations.
  • 3.3 Records: Hospital shall maintain complete medical records and allow Company reasonable access for claims review and audit purposes.
  • 3.4 Emergency Services: Hospital shall provide emergency services to Members without prior authorization, consistent with EMTALA requirements.

4. COMPENSATION

  • 4.1 Payment: Hospital shall accept as payment in full for Covered Services an amount equal to 100% of the applicable Medicare payment amount.
  • 4.2 Billing: Hospital shall submit claims within ninety (90) days of the date of service using standard billing formats.
  • 4.3 Payment Timing: Company shall pay clean claims within thirty (30) days of receipt.
  • 4.4 Member Responsibility: Hospital may collect applicable copayments, deductibles, and coinsurance from Members as permitted under their benefit plan.
  • 4.5 No Balance Billing: Hospital shall not bill Members for any amount above the payment terms of this Agreement, except for authorized patient responsibility.

5. INSURANCE AND INDEMNIFICATION

  • 5.1 Insurance: Hospital shall maintain general liability and professional liability insurance in amounts not less than $1,000,000 per occurrence and $5,000,000 aggregate.
  • 5.2 Indemnification: Each party shall indemnify and hold harmless the other party from any claims resulting from its own acts or omissions.

6. GENERAL PROVISIONS

  • 6.1 Independent Contractor: The relationship of the parties under this Agreement is that of independent contractors.
  • 6.2 Governing Law: This Agreement shall be governed by the laws of the State of Texas.
  • 6.3 Confidentiality: Both parties agree to maintain confidentiality in compliance with HIPAA and applicable privacy laws.
  • 6.4 Entire Agreement: This Agreement contains the entire understanding between the parties and may be amended only by a written document signed by both parties.


IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the Effective Date.


MedSave Management LLC
By: ___________________________
Name:
Title:


[Hospital Name]
By: ___________________________
Name:
Title:

xxxxxxxxxxxxxxxxxxxxxxxx

PROFESSIONAL PROVIDER AGREEMENT

Between MedSave Management LLC and [Provider Name]

This Professional Provider Agreement (“Agreement”) is made and entered into as of [Effective Date], by and between MedSave Management LLC, with offices at [Business Address] (“Company”), and [Provider Name], a licensed healthcare professional or entity, with offices at [Provider Address] (“Provider”).

1. DEFINITIONS

  • 1.1 Covered Services Healthcare services and supplies provided by Provider that are medically necessary and covered under the applicable benefit plans administered by Company.
  • 1.2 Medicare Rate The fee schedule established by the Centers for Medicare and Medicaid Services (CMS) applicable to the geographical area in which services are rendered.
  • 1.3 Members Individuals enrolled in a health benefit plan for which Company provides administrative or network services.

2. TERM AND TERMINATION

2.1 Term: This Agreement shall be effective as of the date above and shall remain in effect for one (1) year, automatically renewing annually unless terminated by either party with sixty (60) days’ written notice.

2.2 Termination for Cause: Either party may terminate this Agreement immediately upon material breach by the other party, following thirty (30) days’ written notice and failure to cure such breach.

3. PROVIDER RESPONSIBILITIES

  • 3.1 Services: Provider agrees to furnish Covered Services to Members in accordance with applicable standards of care and all legal and ethical requirements.
  • 3.2 Licensure: Provider shall maintain all licenses, certifications, and accreditations required under state and federal law.
  • 3.3 Records and Access: Provider shall maintain accurate medical and billing records and grant Company access for utilization review, audit, and claims adjudication.

4. COMPENSATION

  • 4.1 Reimbursement: Provider shall accept as payment in full 100% of the Medicare allowable rate for Covered Services, less any applicable Member copayments, coinsurance, or deductibles.
  • 4.2 Billing: Provider shall submit claims in accordance with Company’s procedures within ninety (90) days of the date of service.
  • 4.3 Payment Timing: Company shall remit payment within thirty (30) days of receipt of a clean claim.
  • 4.4 No Balance Billing: Provider agrees not to bill Members for amounts beyond those specified in this Agreement, except for applicable copayments, coinsurance, and deductibles.

5. INSURANCE AND INDEMNIFICATION

  • 5.1 Insurance: Provider shall maintain professional liability insurance in an amount not less than $1,000,000 per occurrence and $3,000,000 aggregate.
  • 5.2 Indemnification: Each party shall indemnify and hold harmless the other from any claims arising out of its own negligence, errors, or omissions.

6. GENERAL PROVISIONS

  • 6.1 Independent Contractor: Provider is an independent contractor and not an employee or agent of Company.
  • 6.2 Governing Law: This Agreement shall be governed by the laws of the State of Texas.
  • 6.3 Confidentiality: Both parties shall maintain the confidentiality of patient and proprietary information in compliance with HIPAA and other applicable laws.
  • 6.4 Entire Agreement: This document represents the entire agreement between the parties and may be amended only in writing signed by both parties.


IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the Effective Date.


MedSave Management LLC
By: ___________________________
Name:
Title:


Provider
By: ___________________________
Name:
Title: