jmj11 Posted April 23, 2013 Share Posted April 23, 2013 If you had followed our saga (can't find the posting right now) when I opened my own clinic, Group Heath refused to do business with us. I had to drop almost 500 patients. We began a long battle to change this. We met with them. We had letter writing campaigns. The list could go on and on. We got the state Insurance Commissioner involved. Today, in the mail, I have an invitation to join them. Words cannot describe what this means for our clinic as they are the number one insurer in our region. Link to comment Share on other sites More sharing options...
Guest Paula Posted April 23, 2013 Share Posted April 23, 2013 Congratulation, there is hope after all. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 23, 2013 Moderator Share Posted April 23, 2013 Awesome! Congrats! Link to comment Share on other sites More sharing options...
primadonna22274 Posted April 23, 2013 Share Posted April 23, 2013 Good graciousness Mike, that is HUGE!!! I have no doubt your loyal patients raised enough of a ruckus to get the attention of those who wield the power. Way to go!! Link to comment Share on other sites More sharing options...
Acebecker Posted April 23, 2013 Share Posted April 23, 2013 I have followed the battle from afar. Glad to hear things turned out in your favor. I wish you many more successes. Link to comment Share on other sites More sharing options...
Just Steve Posted April 23, 2013 Share Posted April 23, 2013 That is the sound of a excavator breaking new ground...at least metaphorically. Keep up the solid work, pushing forward. Link to comment Share on other sites More sharing options...
d2305 Posted April 23, 2013 Share Posted April 23, 2013 Good news. Now you can go to Nepal or was it Tanzania. Link to comment Share on other sites More sharing options...
burnpac Posted April 23, 2013 Share Posted April 23, 2013 Great to hear this!! I know how persistent you have been on this, and it is nice when persistence pays off. All the best. Link to comment Share on other sites More sharing options...
Joelseff Posted April 23, 2013 Share Posted April 23, 2013 Great News Mike, I remember reading about this when it went down. This is a HUGE win! See there IS light in darkness! Keep trucking Mike, you are an inspiration.... Link to comment Share on other sites More sharing options...
treejay Posted April 23, 2013 Share Posted April 23, 2013 excellent work Link to comment Share on other sites More sharing options...
delco714 Posted April 23, 2013 Share Posted April 23, 2013 Amazing news! A long time coming! Congratulations!! Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted April 24, 2013 Moderator Share Posted April 24, 2013 Congrats! Those after you stand in the shoulders of a giant. Link to comment Share on other sites More sharing options...
CAdamsPAC Posted April 24, 2013 Share Posted April 24, 2013 If you had followed our saga (can't find the posting right now) when I opened my own clinic, Group Heath refused to do business with us. I had to drop almost 500 patients. We began a long battle to change this. We met with them. We had letter writing campaigns. The list could go on and on. We got the state Insurance Commissioner involved. Today, in the mail, I have an invitation to join them. Words cannot describe what this means for our clinic as they are the number one insurer in our region. Wonderful outcome to your struggle! Link to comment Share on other sites More sharing options...
Moderator ventana Posted April 24, 2013 Moderator Share Posted April 24, 2013 Amazing - great job!!!!!!!!!!!!!!!!!!!!!!! Link to comment Share on other sites More sharing options...
medic25 Posted April 24, 2013 Share Posted April 24, 2013 Fantastic! Link to comment Share on other sites More sharing options...
jmj11 Posted April 24, 2013 Author Share Posted April 24, 2013 I am grateful for your good wishes. It has been a long battle and the victory is sweet. Link to comment Share on other sites More sharing options...
rcdavis Posted April 24, 2013 Share Posted April 24, 2013 This is fantastic... What the hell happened? Wonderful gain to your practice.. But the devil will be in the details... Will they be recognizing you as owner and primary practitioner? Will they be sending YOU Letters and referrals, or the SP? What will you be giving up.. I know this potentially opens the floodgates ( the fact that you appear to be the only headache clinic still accepting new patients wouldn't have anything to do with this, would it? ) Did the letter come from low level admin, or someone who counts? I am ecstatic for you.. But they have been so vitriolic and downright prejudiced against you from the beginning.l I cannot help but be suspicious... And would not "cut them any deals" on contracts.... Link to comment Share on other sites More sharing options...
jmj11 Posted April 24, 2013 Author Share Posted April 24, 2013 It is a long story but I will give you a synopsis. I had given up completely. Then, about two months ago, I had some (GH) patients ask me once again to fight for them to get GH to contract with us. I decided to write the Insurance Commissioner. When I explained to him our whole story, he thought we had a case. The commissioner then wrote GH and CC to us. GH wrote back that they had the right to “protect their shareholders” with good investments. The Commissioner sent me a copy of the letter. I prepared a quick presentation (same one I had made to GH) that we were offering their subscribers a better service that in the end would actually save GH and their shareholders a lot of money and the real issue was professional discrimination because I, a PA, was the practice owner. Then the commissioner wrote back to both of us that our presentation made sense . . . but, their job was to protect the public and this seemed to be a disagreement between two businesses and (here was my bait) that they had not heard from a single subscriber. We circled our wagons. We had a file full of both patients’ letters and GH PCPs’ begging to have the opportunity to see us/refer their patients to us. We then contacted about 40 of those patients and asked them to write the commissioner directly and to express to him what they had to us. We had them mail their letters to us so that we could make sure they got mailed in a timely manner. We sent the commissioner a couple dozen of these patients’ letters, mailing a couple every day. The commissioner then wrote back to GH and told them that now they had a pile of complaints against them by their own subscribers and now it was an issue for the commissioner because it involved the public. GH PR wrote back to the commissioner (CC to us) a letter saying that we were putting up patients to complain and we were acting as instigators. I wrote another letter to the commissioner and CC to the GH executive explaining once again that these subscribers had been writing and calling us, and since we had no power to change the circumstances, and the fact that the commissioner had said that he had not heard from a single subscriber, that we simply told these GH subscribers that it made more sense if they sent their complaint to the commissioner’s office (they had already been sending them to GH for the past two years). It didn’t make sense that we were getting all the complaints and there was nothing we could do about it. The commissioner agreed with me then sent a letter to GH (CC to us) asking the executive to address the point that I had made. The GH executive wrote back to the commissioner (CC to us) that he was turning the whole matter over to an internal (GH) ethics and policy panel. We had two weeks of silence. Today I got a letter addressed to me that GH was inviting our practice to join their network and welcoming us. Within the packet was a credentialing application for myself, my SP and the practice. I guess the lesson here is persistence. Link to comment Share on other sites More sharing options...
rcdavis Posted April 24, 2013 Share Posted April 24, 2013 Group health is a nasty group... Tread carefully.. And NEVER Let your practice become so dependent upon them that you cannot live without them. They are not happy with this turn of events, and are only trying to circumvent a directed action and potential lawsuit by the commissioner. Keep them very close, and cut them no deals. Again, congratulations. Link to comment Share on other sites More sharing options...
CAdamsPAC Posted April 24, 2013 Share Posted April 24, 2013 Group health is a nasty group... Tread carefully.. And NEVER Let your practice become so dependent upon them that you cannot live without them. They are not happy with this turn of events, and are only trying to circumvent a directed action and potential lawsuit by the commissioner. Keep them very close, and cut them no deals. Again, congratulations. Keep your friends close, keep your enemies closer...............is the saying Link to comment Share on other sites More sharing options...
shawnmclane Posted April 24, 2013 Share Posted April 24, 2013 Congrats! Great win for your patients, your practice and ironically for Group Health too. Link to comment Share on other sites More sharing options...
burnpac Posted April 25, 2013 Share Posted April 25, 2013 The squeaky wheel gets the oil. Complaints to an insurance is commissioner are nothing to sneeze at, and the can't afford a regulatory / disciplinary fight. Strong work jmj, and you have blazed a trail for your colleagues. Little victories pile up into winning the war. Link to comment Share on other sites More sharing options...
cupojava Posted April 25, 2013 Share Posted April 25, 2013 Little victories pile up into winning the war. Very true. Congrats! Link to comment Share on other sites More sharing options...
jmj11 Posted November 27, 2013 Author Share Posted November 27, 2013 Profound Game Changer. After three very hard years of work, today it became official. We are Group Health providers. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 27, 2013 Moderator Share Posted November 27, 2013 big congrats Mike! well earned. Link to comment Share on other sites More sharing options...
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