For those who don't know, I'm a licensed mental health worker and own a small group practice that treats children & families in my region. Cutting to the chase, my region is fairly small (half a million people or so stretched across a small peninsula in SE Virginia) and most providers like us are required to utilize clients' insurance benefits to provide services. There just isn't enough affluence down here for a fee-for-service model, but regardless doing so wouldn't really be in line with my ethics anyway.

That said, each insurance contract has wording that requires providers to not share reimbursement rates with other providers in the area. Doing so would be breach and we'd be subject to getting booted off the insurance panel. This would obviously suck as maybe 90% of those insured down here are covered by 3 insurance panels...Optima, Tricare East, Anthem...so losing even one could be pretty devastating.

That said, not knowing what my colleagues are being reimbursed makes renegotiating rates with insurance companies challenging. Moreover, being merely a small group of clinicians, the power dynamic is further shifted, as insurance companies know there are only a few panels in our region and so long as the practice isn't massive they can pretty much just dictate rates and let us f*** off if we don't like it.

I'm part of a few online groups of providers and I've been rallying folks around the idea of unionizing, or at least collectively bargaining in some form or fashion. I'm settling on the idea of starting small - reaching out to the local group practices and putting out feelers. If we were to collectively approach insurance panels we'd have to be damn sure we were sufficiently robust that panels couldn't just remove us from their network.

My thoughts are if this initial effort was successful it would likely have a snowball effect; since the initial effort was successful, any additional members to our collective would only improve our leverage for future efforts.

What I DON'T know is procedure. I've taken a course or two on community action planning during my social work years but it's been a minute and I could really use some expertise.

I also don't know if anti-trust laws would prevent this from happening. Colleagues vaguely allude to this but it's become apparent that nobody is specifically knowledgeable enough about it to point me to legislation or legal language that explicitly would prevent groups such as mine from organizing to negotiate collectively against the interests of health insurance companies.

Appreciate any and all feedback.

Wouldn't you want to do a co-op? It seems like you own a business. Get your lawyer to tell you what constitutes another provider, as in what kind of relationship do you have to have in order to be considered the same provider.

Unions are unnecessary and counter productive.

OP, might be a good idea to post this same thread in BFI

Done

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Firstly I have no real idea about the specifics of your line of work and the relations between insurance firms, providers and services users. I can make some general observations though.

I expect you will want to tread extremely carefully. Organising in a workplace is difficult enough, colleagues will rat on each other just for the chance to get ahead. You have, I assume, competing providers in your area, if one was to lose its contracts with an insurance firm that is good news for the others, correct?

What is the potential for companies removing all of you troublemakers on masse and replacing you with outside providers?

This strikes me as a much broader question of the role of insurance firms in provision of services. Are there existing local or regional campaigns underway, umbrella groups you can latch onto? Where do existing unions stand and can they support or lead on it so you can take more of a backseat role? Service user groups ie the public, could they have a campaign group? Can local politicians be lobbied to change legislation or pressure the companies into paying fair rates?

You say it is in the wording of the insurance contract that you don't speak to other providers about rates. Can a member of the public put in a freedom of information request to find out? Is there oversight /public accountability on this - there is public money being invested I expect?

Going forward what do you want to achieve? Each contract I imagine will have a different set of objectives and will have factors that determine the rate. Part of this will be insurance firms maximising their own revenues. You want a seat at the table where this is worked out so you can ensure fair rates?

Good luck!

Typically the first step is to drum up support and see how many interested parties you have. Then typically you contact an umbrella organization and find out what you need for them to pick you up. This way you gain access to a larger network of resources to draw on (but of course, also a larger bureaucracy and the potential for having to choose external politics over internal).

Other than that I'm out of my debt when it comes to US union politics. Though my impression is that unions there have a far tougher time than in my country, where union-employer relations tend to be fairly formalized and constructive.

Yeah, damn that 1st amendment.

You should form a partnership with the other practices and create an oligopy of your own. Owners don't need to unionize.

Yeah this is what I was going for too. Would need to get like 5 or 7 of the big practices on board and then draft some kind of letter as a group that would make certain demands. Would need to start with an insurance company we'd all be less likely to fold on if and when they refused to negotiate, but mostly we'd just want to make sure we had a keen understanding of the market and how much of said market we as a whole represented.

I think a huge challenge will be that there would be an incentive for one or more of the big practices to defect and try to scoop all the business.

I think the law would stop you.

Lol, antitrust law is completely inapplicable. I used the term oligopoly in jest because he is dealing with three insurance companies that have an oligopoly of their own in his region.

Nothing would prevent him from forming one big practice that dominates a medical sub-specialty other than the egos and greed of the prospective partners.

LOL, I seriously was not referring to your post.

Just so the pattern of your behavior is completely obvious.

See jjjou812, when I'm wrong, I admit it. You....deflect.

I wish I could help but I don't know enough about the law and unions specifically. The only advice I could give would be to reach out to a big union close to you, no matter in what industry, and ask.

Anti-trust law is the only consistent reason I encounter for not organizing in some form or fashion. I don't think merging practices is the solution but do think some kind of joint venture for the purpose of negotiating improved rates could be beneficial. Just don't know enough to organize it effectively.

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Anti-trust law is a joke. The reason why these laws were passed in the first place was because the upstart trusts were selling their goods for too low of a price, and the established business interests couldn't complete with them. Unable to compete in the marketplace, they decided to lobby congress instead. Anti-trust has never been about the interests of the consumer, and has always been a club with which politically connected firms can smack their competitors.