The legal side of care

Jillian Jagling, health care attorney and member of the corporate and business team at Pannone Lopes Devereaux and West LLC, recently published a white paper titled “What’s in your Provider Contract?” The document highlights several compliance and regulatory issues, providing a comprehensive overview of the complex insurance environment. Prior to joining PDLW, Jagling served as a staff attorney for Blue Cross & Blue Shield of Rhode Island. She also served in the U.S. Army Reserves for eight years as a paralegal in the 3rd Legal Support Operations Unit in Boston. She holds a B.A. in English from Assumption College and a J.D. from Roger Williams University School of Law.

What are some issues currently facing the health care industry?

The health care industry continues to work toward improving and innovating in care delivery, sharing data more broadly and improving the way providers are paid. Technology, data and analytics are fueling rampant innovation. However, standardization, accuracy, interoperability and privacy of data are challenges, as well as compliance with various and yet-to-be-drafted regulations.

Why are providers in a network at an advantage over nonparticipating providers?

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Historically, participating providers were at an “advantage” over nonparticipating providers because they were guaranteed a set payment directly from an insurer based on their contract. Without a contract, there is less certainty about payment arrangements, and non-participating providers often must collect payments from patients. Recently, consumers are tending to select high-deductible health plans, which means that participating providers are now facing the same challenge of collecting from patients as non-participating providers.

Could you tell me more about your work in the U.S. Army Reserves?

Initially my work in the military ranged from transporting passengers, cargo and equipment by air, land and water, to operating all types and sizes of cranes and forklifts to load and unload supplies and equipment from ships, docks, beaches, railheads, vehicles and aircraft. •

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