Should practices "get tough" with insurers?

This week, as part of my coverage of the Medical Group Management Association's annual meeting, I wrote about how hard it's getting to make a profit as a medical group. In an editorial, I noted that for many types of groups (including some lucrative specialties), expenses are rising faster than revenues, something which obviously can't go on forever.

In response, a practice manager from California wrote in with this take:

"I believe that doctors have to get tough with these heartless insurance companies. I read in Physician's Practice a while back that the pediatricians told the parents that the insurance companies were not reimbursing appropriately and that they were not going to dispense vaccines until the insurance companies coughed up the money. This is the kind of hardball that physicians need to play. If we pay $10 for a vaccine I expect that we will be reimbursed properly. If we are not, the parents are sent a bill. When they return for a visit and have not paid, then we tell them that they can (a) pay what they owe or (b) re-schedule for a time that they can pay. (Our office) is not a free clinic and I do not believe that physicians should be in the business of losing money. I will NOT stand for it."

With all due respect to my correspondent, my feeling is that while groups should hold the line with insurance companies, they're not going to get much more juice out of them at this point. On the other hand, they can certainly tighten up patient collection measures--after all, you have more leverage with patients, who at least stand there and look you in the face. 

Readers, do you think that groups can regain their footing financially by drawing a line in the sand with insurance companies? (I'd love to hear stories of how you won the day in battles like the one outlined above.) And OK, maybe one group doesn't have sufficient clout on its own, but if most groups pushed harder, would it work? Or are we on the verge of some major shifts toward business activities that don't involve collecting from a health plan? - Anne