When to Walk Away From an Insurance Company

Physicians in small practices often have little say about what they are paid by insurance companies. We accept what they pay us, especially in the beginning. Over time, you discover which payors do better than others. And you can either go on accepting that-or you can attempt to renegotiate. Sometimes it works. We were able to get one company to stop routinely down-coding all our visits. But sometimes it doesn’t work. And you have to be prepared to walk away.

We recently did just that. Our requests to renegotiate a soon-to-expire 8-year-old contract were met, not with reluctance, but with outright indifference. We received no response to emails or to a certified letter. On the telephone, we were told that our concerns would be forwarded to the appropriate department. We didn’t hear back. We then informed the company that we would not be renewing our contract if they did not at least come to the table to negotiate. Again, this decision was met with indifference. This despite the fact that several other endocrinology practices in the area had already dropped this plan.

It was a calculated risk. We were concerned that we would lose several patients. We knew, however, that we receive several requests a day for new patient appointments from patients with other insurance plans. So, we figured we would eventually catch back up to our usual patient population. It turns out that most of our patients with this plan are planning to continue to see us and pay out of pocket. Many of them have $50 to $70 copays anyway, so what’s a little more to stay in a practice where they are happy with their care? It is humbling to know that so many of our patients value the health care we provide-enough so to continue to come despite our being out of network.

So, guess what? The insurance company loses nothing. The patients or their employers continue to pay premiums, but we’re one less office visit the company has to pay for. Until patients put pressure on their employers to provide them with different insurance coverage, the insurance company has no incentive to negotiate with physicians. And the laughable thing is, representatives from the company keep calling to tell us that even if we are not participating providers, we can still submit claims and get paid the in-network rate. Hello? The in-network rate is why we’re leaving.

Whether this is the only company we will stop participating with or if this is our first step toward going cash only remains to be seen. We will have to see whether any new patients with this plan decide to make appointments or go elsewhere. Rumor has it that another endocrinologist in the area is dropping this insurance company too. Its clients can only hope that this pressures the company into reassessing how it compensates physicians.