Orlberg

Throughout the term of this Agreement, Orlberg shall maintain at Orlberg’s expense general and professional liability coverage in a form and amount acceptable to Aetna. Orlberg shall maintain a minimum amount of $250,000/$5 million general liability insurance. As a small rural hospital I am not sure that they would be able to afford that. Would this be something that would be able to be negotiated before the contract is signed.

In Exhibit A, the amount that is being reimbursed by Aetna should the agreement be signed would be less than the previous year, would Olberg then be functioning at a loss, or are these reimbursement numbers being calculated based on a decrease in the cost of care.

Payments Covered Services under this Agreement are subject to the Payment Policies. Such Payment Policies may change from time to time. Aetna will make information available regarding such Payment Policies upon request or at website identified by Aetna. There is time frame for notification of changes. There should be at least a 60-day notice before changes are made to payment policies.

Upon request to Aetna, Orlberg shall provide to Aetna a copy of Participants’ medical records and other records maintained by Orlberg relating to Participants for purposes of conducting quality assurance and peer review. Is Aetna legally allowed access to participants’ medical records for quality assurance and peer review purposes. In general, health insurance companies do not have the right to inspect your medical records other than for purposes of determining eligibility for health care coverage (MedicalRecords.com, 2015). 

References

MedicalRecords.com. (2015). How Will My Medical Records Affect My Health Insurance. Retrieved July 15, 2016, from MedicalRecords.com: http://www.medicalrecords.com/consumers/how-will-my-medical-records-affect-my-health-insurance-2