Resolution 03-2012: Enrollee Hold Harmless Clause

WHEREAS: True medical insurance in the United States is rare to virtually nonexistent; and

WHEREAS: A third party prepayment system has supplanted insurance and direct payment for routine medical services; and

WHEREAS: Third party prepayment destroys the patient-physician relationship, and short-circuits the normal regulatory mechanisms of a free market, leading to perverse incentives, shortages, and cost escalation; and

WHEREAS: The foundation for the business model of the third party prepayment system is the Enrollee Hold Harmless Clause that is a part of virtually all provider contracts; and

WHEREAS: The existence and significance of this clause is generally concealed.

BE IT THEREFORE RESOLVED that the Association of American Physicians and Surgeons educate employers, insurance subscribers, and physicians about the significance of the Enrollee Hold Harmless Clause.

Hospital/Doctor agrees that in no event, including but not limited to non-payment by Insurance Company, Insurance Company’s insolvency or breach of this agreement, shall Hospital/Doctor, one of its subcontractors, or any of its employees or independent contractors bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against a Subscriber or persons other than the insurance company acting on behalf of Subscriber for Covered Services provided pursuant to this Agreement. This provision shall not prohibit the collection of coinsurance, co-payments or charges for Non-Covered Services. Hospital/Doctor further agrees that (1) this provision shall survive the termination of this Agreement regardless of the cause giving rise to termination and shall be construed to be for the benefit of the Subscribers, and that (2) this provision supersedes any oral or written contrary agreement now existing or hereafter entered into between Hospital/Doctor and Subscribers or persons acting on their behalf. Hospital/Doctor may not change, amend or waive this provision without prior written consent of the Insurance Company. Any attempt to change, amend or waive this provision are [sic] void.