by jerry on March 01, 2020
Kaiser Health News reported on what can happen when a major health insurer (in this case, UnitedHealthcare) dominates a clinic's payer mix. The insurer might have its own reasons for dropping a provider from its network; if nothing else, insuring the majority of a clinic's patients gives that insurer much leverage in rate negotiations.
In theory, something similar can happen in reverse, when insurers feel they must have a specific provider group in its network. In that case, that particular provider group can more easily negotiate for higher rates. The broader issue is that concentration of market share can give disproportionate leverage to one side or another.