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Can you answer a question for me? An insurer offers a doc a contract under which the doc agrees to take the insurers' patients in return for that business, and the guarantee of payment from the insurer at the rate set in the contract. The contract says nothing about the insurer being able to change the rate of payment unilaterally. The contract has a four year duration. Two years later, the insurer lowers the rate of payment. The doc calls and asks why. Insurer says "we have the right to do so." Doc says "uh, uh... no you don't." Insurer says "take it or leave it." Seems to me the doc has a lawsuit if he wants. Or am I missing some common industry custom here? In my dealings with isurers, I have learned that contracts tend to be narrow when they're enforcing them, and tend to be read rather expansively by insurers when they want to get around their terms. ETA: BTW, why do insurers say things like "Oh, well, you have an old contract. The new ones don't say that anymore," when you try to enforce someone's rights? I find that baffling. Do some states have law that holds that subsequent contracts for similar benefits can modify the terms of previous contracts with other parties? That can't be the case, but I can't think of any other reason for an insurer to say something like that. And its happened to me twice. |
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ETA if it's really insurance you are talking about (and not just payments -- like, where I work, the company pays all claims, through a third-party administrator, who might also be an insurer (Aetna, BCBS, whatever) -- but it's not an insured arrangement. I think we may have stop-loss insurance for if an individual's claims exceed $X in a year, or over a lifetime, or whatever, but not sure), it's heavily regulated and it may be that if the insurer gets a new contract approved by the state regulators, it overrules the old contract. |
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Eventually, all of the local docs get frustrated, form a sub-specialty IPA, the one hold out doc (or the insurance company if none of the docs hold out of the IPA) start going after the IPA for antitrust violations. Usually the docs aren't integrated enough, though sometimes they can work the IPA to their advantage. |
Peace Process
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Peace Process
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WTF's happened to you? |
Peace Process
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Peace Process
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Peace Process
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Peace Process
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Peace Process
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Chocolate Town
If you haven't done so yet, find and listen to all of Ray Nagin's comments of two days ago. I understand what he was trying to say, but what actually came out of his mouth was what I'd expect to see if the folks who did Best in Show did a movie on politics. His comment about "mixing milk and dark chocolate" and "making a delicious drink" was surreal. I haven't felt that embarrassed for anyone since watching Bush in the 2004 presidential debates.
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Chocolate Town
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In some ways I think Nagin is a Democratic complement to (say) Jeff Sessions. The distinction between them would be, presumably, that only the things Nagin actually says are borderline retarded. |
Clinton, not Hillary
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Chocolate Town
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http://images.amazon.com/images/P/B0...CMZZZZZZZ_.jpg |
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