Today's main event: how a physician-owned practice negotiates with UnitedHealthcare. UHC is notorious for raising premiums 20 to 30% while offering physician reimbursement bumps of about 1%. I walk through exactly how we push back at Eye Health Northwest, phone messages that spell out the math, letters to patients, and yes, taking the contract to the brink when we have to. This works because we're large and physician-owned, which is why I make the case for other independents to consider joining forces locally instead of selling to private equity or chasing the Sound Physicians model.

After the break, a quick "don't do that" tip, and some actual advice for the residents and interns who just started on July 1.

Takeaways:

UnitedHealthcare consistently reimburses below other commercial payers, often raising premiums 20 to 30% while offering physician reimbursement increases as low as 1%, the ability to push back depends heavily on practice size and market share

Eye Health Northwest formed 40 years ago when three independent practices merged, creating the scale needed to stay physician-owned, avoid private equity, and negotiate meaningfully with big insurers, a model Will recommends for other independents willing to stay local

The most effective renegotiation tactic is patient transparency: phone messages, letters, and clear math about premium hikes versus reimbursement stagnation motivate patients to pressure the payer directly, which is what ultimately gets big insurers to blink

Covering an entire long-weekend call solo across all practice sites is a very different animal than typical private-practice call, Will openly acknowledges that private-practice ophthalmologists have lost perspective compared to residency call at a level one trauma center

Advice for new residents: check vision before consulting ophthalmology, stay humble, listen to patients before the system beats it out of you, protect a few minutes a week for something completely outside medicine, and invest heavily in your co-residents — no one else will fully understand what you're going through

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