I’ve alluded to these stories before but I want to tell one of them again, with an up date.  These are things that you could never foresee when you plan a business.  Everyone who has never done this would argue that somehow they are too smart or talented to allow these things to happen . . . but in reality, there is nothing they can do. We we chose our office space, I picked the newest and prettiest office building on our island. I think it was a smart choice. As part of our SBA loan, we had to sign an agreement that I would not leave this space for six years, the duration of the loan. We we first moved in, and had given out our address to all important entities, we noticed we weren’t getting any mail. Now the Post Office is just up the street and I’m sitting here typing and can see the top of the building easily. But, to my horrors, the Post Office told me that they did not deliver to this building.  I spoke to the Post Master and he said they “never would and never will.”  That was the only reason given.  They had also sent back all of our mail as “no such address.” This caused a huge amount of nightmares including having our malpractice cancelled because we didn’t pay the premiums. It also caused a stir with many of our vendors, such as insurance companies. Finally we had to get a PO Box at the Post Office while we continued our fight.  We had to give a “change of address” to the PO Box. This created a month delay in getting our payments and almost caused us to go bankrupt last summer. I was about to give up the fight in December, when Regence and a couple other insurance companies announced that they would no longer do business with practices who receive their mail via PO Box.  One insurance company had already denied $3,000 in claims because of having a PO Box.  I had to move forward more aggressively. The Post Office finally agreed to deliver mail but only of the mailman didn’t have to get out of his truck.  There was only one spot where a mailbox could go. The landlords denied permission to put it there.  I had to make the empty threat to move out (empty because if we moved out we would violate our contract with SBA and I would be force to pay them $65,000 immediately). So, finally the landlord approved the site. The post master took another month to give his approval. Then we put in our “change of address” to all entities. Oddly, every single insurance company, which refused to do business with us because we used a PO Box, only had PO Boxes. They are bullies and hypocrites! So, while we remain working our asses off, suddenly our income started to dry up again.  Today, we finally had the chance to work on that. It turns out that if you do a “change of address,” in our case from a PO Box to a street address, it is counted as a “move.” So, if a practice moves, then the insurance companies denies payment until they credential you at a new site. This is so frustrating and they don’t care if this makes no sense. Any excuse to delay payments makes them richer. The last one, which had not paid us in a month, was medicare. We called them and said because we moved they would withhold all payments for 4 months. That was the last straw for me so I called my congressman this morning and we are working on fixing this. But who would have guessed that this would create such a nightmare for a small business.  

Yesterday I went to the post office.  In the mail I had another $550, which will keep us in the black for payroll tomorrow. My heart was encouraged. Then . . . there was a funny little card that I had to take to the front window. It was a certified envelope. I opened it. It was a letter from another one of our insurance companies saying that they will not do business with us anymore. Words can’t describe how frustrating this is.  This will launch me on another long, hard battle. It will probably cost me then thousand dollars by the time I’m done with it and many sleepless nights. It is so frustrating because you can’t just sit down with someone and explore it. Insurance companies are bullies. They hid their cards close their chest.  We fought with Group Health all the way to the top. At the top was only smoke and mirrors . . . no answers. One has to assume that it has something to do with me being a PA, a specialist and a clinic owner. I just wish they could come clean and we could have a reasonable discussion about it. But no.  They may never tell me. So tomorrow I throw down the gauntlet. I will fight this to the bitter end . . . alone.

The landmark is a psychological one. But due to the fact that I’ve had about $8,000 come in this week (I need about $900 per day x five days per week to keep the doors open), I have a good working team for now, I’m sleeping well these days . . . that I can say in confidence that I’m glad I did this.  I have not been able to say that with confidence in many months.  I just hope it last.

Today we closed the books on our ninth payroll with no help from the bank. This time our margin was about $5,000 in the black.  That is much better than the $35. just a month or so ago.  We are not out of the woods but my bills are paid and the schedule remains mostly full. My sleep tonight should be sweet.

So, I’m sitting in Mesa, Az waiting for my flight back home. We were just told that it will be another hour wait so  have time to chat. I was here for the Scottsdale Headache Symposium.  We finished early this morning (10 AM) so my wife and I hiked from the hotel to the top of Camelback Mountain (pictured). It was a 5 mile round trip hike.  The climb up the mountain is 2.5 miles of that. It is steep. Very Steep in places and 50% of the “hike” is bouldering. They have these strange metal rails up the steepest parts, which do help. So, I’m a bit tired. But this is also a respite from clinic climbing. My mind has been able to get away from the grind for time to reflect.  On Thursday night I did a presentation to a group of NPs and PAs about my process.  I was almost moved to tears when so many came up and said dumb things like “you’re my hero.”  I was moved to tears because I feel like for the past year I’ve been one of those adventurers who is skiing, solo, across Antarctica. It is nice to be with PAs and NPs who understand what I am talking about when I struggled with banks who would not loan to a PA who is trying to start a clinic, or malpractice insurers who couldn’t get their heads around the idea. I had some quality visits with my SP, whom I brought to the conference. I got to rub shoulders with many old colleagues.  It has been a good time. I’m going back feeling refreshed, and with a new zeal.  I see things I need to fix in the way we do business. I have some new dreams of expanding into different cities and into SE Alaska. It has been good indeed.