jmj11 Posted July 12, 2012 Share Posted July 12, 2012 Group Health Cooperative is the largest insurer in our area, accounting for almost 1/3 of the covered, commercial payers. I had been following 500 of their patients prior to starting my own clinic. One year ago, to my amazement, they refused to contract with my clinic, causing the immediate abandonment of those 500 patients. We entered a year long process of appeals and presentations all the way up to the top of the organization. After this year of strong effort, today they once again upheld their original decision to boycott our clinic. This is great loss for their members and my previous patients as there is no one else with 100 miles who makes any claims of being a headache specialist. As we made a stellar presentation showing that we provided superior care (actually the only care), lower cost and higher patient satisfaction so this decision was made on purely a political ground. This is sad commentary and their members will be those who loose the most. We are overwhelmed with business so we don't need them. But I do care deeply for the patients. Link to comment Share on other sites More sharing options...
andersenpa Posted July 12, 2012 Share Posted July 12, 2012 I forget- did they explicitly say that the boycott was because you are PA owned? What was their rationale? Link to comment Share on other sites More sharing options...
jmj11 Posted July 12, 2012 Author Share Posted July 12, 2012 I forget- did they explicitly say that the boycott was because you are PA owned?What was their rationale? They can't legally state that as it would be a slam dunk suit for restraint of trade. I've made the statement to them and they haven't denied it. I only made the statement to them when I pointed out that all their reasons for rejecting us were false. For example, their first response was that all their headache patients were well care for at my old practice therefore they didn't need a new headache provider. Then I had the statement from my old practice that it was I, 100%, who had seen their headache patients over the last 8 years. Therefore, if I was moving to the new practice, I wouldn't be at the old practice. Then they stated that none of their in-network providers had requested our service. Then I did a letter writing campaign and had about 40 of their area in network PCPs write them and ask for our service. So the excuses fell one by one. I pointed out that it must be purely political because I'm a PA owner . . . and they kept a poker face and never said anything. I offered a lower contract rate. I proved a higher patient satisfaction with us Vs alternatives in the region. So, you figure it out. Link to comment Share on other sites More sharing options...
primadonna22274 Posted July 12, 2012 Share Posted July 12, 2012 Time for an op-ed in a prominent local newspaper Mike? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 12, 2012 Moderator Share Posted July 12, 2012 agree with prima. and get your old sp at mayo to cosign your letter to the editor. and see if you can convince many of those folks to switch insurance. offer to have your office staff do the paperwork to switch them to an insurer that accepts your clinic. make them bleed money.it is the only thing they will understand. Link to comment Share on other sites More sharing options...
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