With the recent growth of MCOs, many physicians have contracted with insurance carriers to treat any patient insured by that carrier. This obviates the physician’s right to refuse to treat. A person who is injured because a physician wrongfully refuses to accept him or her as a patient may sue the physician based on this contractual agreement with the insurance company. Unlike traditional physician–patient relationship law, which is based on the physician–patient dyad, MCO contracts can create a physician–patient relationship with a class of persons rather than with a single individual. When a member of this class requests treatment, the physician has the responsibility to treat that person as an accepted patient.
Closed-panel MCOs are the most restrictive type of health insurance scheme. The degree of restriction on the patient’s choice of physicians varies among organizations, but in general, closed HMO patients have a physician assigned to care for them. The physicians have even less choice of which patients they may treat. In this situation, the traditional assumption of a freely determined physician–patient relationship is inapplicable, and the physician’s duty to the patient probably begins when the patient is assigned as part of the physician’s panel. In preferred provider organizations (PPOs) and other MCO arrangements in which the patients have a smaller copayment if they are treated by certain physicians, the choice of physicians is limited, but unless the list is very short, the patients still perceive that they are choosing the physician. The physicians’ position is more ambiguous. They may retain the right to refuse to treat patients of their choosing, but it is more usual that the PPO contract requires them to treat any PPO patient who presents in the office, subject to limitations of scheduling and specialty practice.