Seems like they are writing the unwritten.
Different medical insurance policies have different organizational structures coordinating between 7 to 20 entities, each with massive relational databases to operate in the industry. (e.g. within one regional healthcare system commonly accessed service providers in an outpatient surgical procedure might include: Patient, Dr., Dr’s Group, Pharmacy, Lab, Admissions, Insurance Provider, Radiology, Anesthesia, Emergency Room/Trauma Center, Ambulance, Physical Therapy).
Different plans group those services in different fashions based upon local economies of service. Any two or more of those groups may also engage in “co-pay” systems.
The clause seems to be allowing all the different plans to implement their operations in their own fashion, but failing to recognize their ‘granting’ of that freedom, might be encroaching upon the contractual relationships between service providers within their systems.
I haven’t seen a model showing the difference in ACA and the relationships in standard healthcare systems.
“I havent seen a model showing the difference in ACA and the relationships in standard healthcare systems.”
I think the biggest difference is that the usual models were designed by people driven by profit (good thing.)
These regulations are being written to shut people up, or make someone happy, or push a goal forward. The final cost is irrelevant. Other people’s money, and all.
I appreciate your analysis of that clause and it makes sense but while you’re viewing it contractually and it would seem with some inside knowledge of the healthcare system, I view this through the prism of a government that slips seemingly incoherent verbiage into legislation with the sole intent of providing a means to further screw us :-).