jmj11 Posted July 6, 2011 Share Posted July 6, 2011 Okay, looking for some advice here again, believing that there is wisdom in the "herd." You haven't steered me wrong before. Okay, I have a new headache clinic, which I own (nothing new here). The major insurer in our region is Group Health Cooperative. I've seen their patients, as an employee in a neurology group, for the past 8 years. However, now that I own the practice, they are boycotting it. I have about 800 GH patients who are now being abandoned. Their PCP won't see them nor will my old neurology practice see them. I have been fighting with GH since April. I was rejected and I appealed to the next level. I went through another layer of severe scrutiny . . . only to be rejected again, with the only reason me being the owner. I have appealed, and requested a meeting with the CEO. i was notified today that meeting will be granted. In my letter, requesting the meeting, I said I would like to bring my attorney. I also mentioned, unless they they give a good reason for the boycott, it is an assumption that it is a violation of the restraint of commerce act. I have a PA friend who owns his own FP clinic. He encouraged me to take this tough stance at this juncture. However, I had a discussion with my SP on Friday. He is willing to come with me, but he strongly encouraged me NOT to bring an attorney and NOT to mention anything about restraint of commerce act, but to keep the meeting very cordial. His point is that I do not have the money or time to pursue a suit and they know it. My threats will only alienate them and close the door for doing business forever. So, what do you think? I've had a very long string of battles over the past six months and I'm in a fighting mode. However, I do realize that there is a careful tactfulness in these things. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 6, 2011 Moderator Share Posted July 6, 2011 remember patrick swayze in "roadhouse"? "be nice until it's time to not be nice". start easy. you can always call in the cavalry later. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted July 6, 2011 Administrator Share Posted July 6, 2011 Copious contemporaneous notes. Keep asking; their contradictions will be problematic. Keep them talking, and if they just *happen* to say something legally actionable, it's not your fault. Remember, the longer you keep them talking, the more conversations that you know about and can seek in discovery if and when it ever gets to the lawsuit phase. Link to comment Share on other sites More sharing options...
Beorp Posted July 6, 2011 Share Posted July 6, 2011 If they know you don't have the time or money to actually sue them then it seems like the only real option is to keep it cordial. It seems like it would be a big risk coming in there appearing as if you're ready for a fight and having them call your bluff. Might was well start by just chatting and then if you need to escalate things later you always can. It doesn't seem like there is much to lose by giving the cordial approach a shot though. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted July 6, 2011 Administrator Share Posted July 6, 2011 Oh, and I would never suggest attacking any large organization directly. You need to discreetly find their enemies--insurance commissioner, elected official, etc. and sell them the headline: "Group Health conspires to keep low-cost specialists out of marketplace" sounds pretty good to me. Might or might not sound good to an attorney general; at those levels, political motivation is inescapable. If you haven't already done so, you should budget for appropriate political contributions. Link to comment Share on other sites More sharing options...
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