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.


Sent from my SM-G892A using Tapatalk

So you want to form a cartel?

Maybe?

Sent from my SM-G892A using Tapatalk

I dont see what this has to do with business, finance or investing, hence the lock