Small Practice Takes On Big Payer, Round 77

Over on PartnerTalk (the PCC user mailing list), one of our clients mentioned trying to get UHC to the table three times and failing.  I pointed out that the insurance companies have no motivation to pay attention to a small pediatric practice until you force them to do so – namely, by dropping them.

I sent everyone on PartnerTalk over to the awesome Pediatric Inc. blog to read a piece I wrote a few months back about the math of the dominating payer.  I should probably turn my long comment (in the middle, hard to miss) into a proper blog entry for myself.  Anyway, a PCC client added this comment yesterday:

Taking heart from Chip’s remarks, I discovered that one of the networks
that we were contracted with (an arrangement we “had”to make because a
local employer had gone with them) was now paying 50% of charges. They
had changed name several times with mergers etc., and were very
difficult to actually find some one to talk to. I indicated that we
would have to drop them if they did not offer us a better rate. No
reply. Sent a registered letter with a sample letter informing patients
that we could no longer participate and named a date when we would send
it out. we got the signature card back, but no answer. Made a phone
call and were told that there was nothing to negotiate. Sent another
sample letter, this time telling the patients that we were disconsolate
that their insurance co not only would not cover their children
adequetely, but refused to talk to us. We were promised a new fee
schedule to look at , but it did not come in a month. So one last email
telling them Sayonara, and we got back a contract offering 135% of
medicare. What do you think, Chip?


I can’t make this stuff up!
  This is a small, small rural practice in Vermont!  It isn’t some 25 physician, multi-specialty group with a professional negotiator.

135% of Medicare in a small rural VT practice.  With a few letters.  How hard was that?

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