Can it be Enforced?

This is a question that physicians need to ask in lots of scenarios:

1) Non-compete Agreements - I've read lots of physicians contracts over the years, and the majority of these agreements are not written with language narrow enough to be enforced, and in some states they would not be enforced under almost any scenario.  In general, your (likely hospital employer) is hoping that this clause will intimidate you enough that you will not attempt to leave - even as your pay guarantees fall off after the first year or two and your salary is severely slashed.  Don't be intimidated!  A non-compete is generally not a reason to hold off starting your own DPC practice.  Check out this 70+ page AHLA document for more details (state by state analysis at the end).

2) Orders Ignored - A Blue Cross / United / Cigna / Aetna (BUCA) insurance company is refusing to follow your orders for an anti-CCP antibody or a brain MRI.  Is this legal?  What about the "any willing provider" laws?  Can you rely on these to force the insurance company to honor your order?  Generally no.  As a DPC physician you can advise the patient that his insurance company is a bad actor.  You and the patient could agree to go to the press and make the insurance company's bad behavior public.  You and the patient cannot force the insurance company to honor what amounts to your "out of network" orders.  "Any willing provider" laws typically allow the physician to argue that the insurance company must be willing to allow the physician to join the insurance company's network at similar terms to other physicians, and this right to join the group is generally all that is conveyed.  As a DPC physician you are typically out of network and not contracted with the insurance company in any way, and thus you have no rights to enforce against them.

Happy Fourth of July!  Feel free to comment in the forums or by clicking the blog title.