Quote:
Originally posted by sebastian_dangerfield
True. Good point.
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.
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Those agreements are usually fairly easy to get out of. Doc says no way, insurance company says fine, terminates the agreement, and moves on to the next doc.
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.
