BUSI 302 Week 4 Discussion Board Forum 2 Replies Example

Discussion Board Forum 2 Replies: Responding to Classmates on Contracts

BUSI 302 Legal and Ethical Issues in Healthcare, Discussion Board Forum 2 Replies

Thread by [Student Name]

The classmates and their workplaces are composites; the textbook and the journal articles cited are real.

Reply to Keisha

Keisha, your example of the patient who signed your practice's financial responsibility form and then received a $3,800 bill from an out-of-network anesthesiologist shows how a contract a patient signs at the front desk may not protect her from charges she never agreed to. The good news is that federal law has changed this. Financial responsibility forms are contracts, but a contract cannot waive protections that federal law gives patients, so the form's wording does not decide what she owes. Ukert and Gordon (2025) explain that the No Surprises Act, implemented in 2022, has protected patients nationally from surprise bills in most settings, so in a case like hers, the patient should owe only her in-network cost sharing. The dispute moves to the anesthesiologist and the insurer.

That shift has its own costs. In 7,076 arbitration disputes involving one large insurer in 2023, providers won 80% of cases, and median awards were 3.72 times the qualifying payment amount and about twice local in-network rates (Ukert & Gordon, 2025). Murtagh et al. (2026) describe how provider lawsuits challenging the Act and its rules eroded its payment method and drove heavy use of arbitration. Patients are protected at the bedside, but premiums may absorb the cost. For a billing office, that means two jobs: making sure patients are not billed improperly and making sure the practice's own out-of-network claims follow the dispute rules. A form a patient signs at the front desk cannot take away protections the law has already given her. Has your practice updated its financial responsibility form to explain these protections, or does it still read as if the patient owes every bill?

Reply to Ryan

Ryan, I appreciated your candor about reviewing a new employment contract after a private equity firm bought your gastroenterology group. Research gives you some useful questions to ask. Singh et al. (2022) compared 578 acquired practices with 2,874 matched controls and found that prices paid per claim rose 11% after acquisition. In primary care, Singh et al. (2026) found that acquired practices billed 30% more services and saw 11% more patients per physician, with growing reliance on advanced practice providers. Taken together, those results suggest that productivity expectations are likely to change, so look closely at any clause tying your pay to volume. Also check whether the contract changes who controls scheduling, staffing and referrals, since those decisions affect both your workload and your patients' care.

This week's chapters on professional liability raise another point. Judson and Harrison (2016) distinguish claims-made malpractice policies, which respond only to suits filed during the coverage period, from occurrence policies, which cover any incident that happened during it regardless of when the suit arrives. If the new owner provides a claims-made policy, ask who pays for tail coverage if you leave, since that can cost tens of thousands of dollars. Some contracts shift that cost to the physician who resigns but not to one who is terminated, and the difference matters if the relationship with the new owners does not work out. A physician who leaves without tail coverage can be personally exposed for years to claims arising from care given under the old contract. Does your contract also include a noncompete, like the one I discussed in my thread?

References

Judson, K., & Harrison, C. (2016). Law and ethics for the health professions (7th ed.). McGraw-Hill Education.

Murtagh, L., Rahim, A., & Fuse Brown, E. (2026). Litigating the No Surprises Act: How legal challenges undermined cost containment and reshaped provider payments. Health Economics, Policy and Law. Advance online publication. https://doi.org/10.1017/S1744133126100723

Singh, Y., Dixit, M. N., Trivedi, A. N., & Whaley, C. M. (2026). Private equity acquisitions in primary care: Changes in utilization, spending, and workforce. Health Affairs, 45(6), 629-636. https://doi.org/10.1377/hlthaff.2025.01703

Singh, Y., Song, Z., Polsky, D., Bruch, J. D., & Zhu, J. M. (2022). Association of private equity acquisition of physician practices with changes in health care spending and utilization. JAMA Health Forum, 3(9), e222886. https://doi.org/10.1001/jamahealthforum.2022.2886

Ukert, B., & Gordon, A. S. (2025). Arbitration outcomes for out-of-network medical bills under the No Surprises Act. Inquiry, 62, 469580251401475. https://doi.org/10.1177/00469580251401475