It's 5 a.m. in the morning, and Cuddy gets up, exercises, and takes care of Rachel. She then showers and dresses for work as the sitter arrives. Lucas comes in and Cuddy says that Rachel isn't feeling well and she's running late. He suggests that she stay for ten more minutes for sex, despite the fact she has a proposal to present in less than an hour. As they go to bed, House calls but she ignores it. The experience is less than satisfying for Cuddy by the time Lucas finishes, and she looks at herself in the mirror and tells herself she can do it.
Cuddy arrives at work, and Nurse Regina greets her. House is waiting for Cuddy and tries to discuss his current case. When she refuses, he explains that he was on a stakeout with Lucas, and they bet whether House could interrupt them in the middle of sex. Cuddy refuses to confirm or deny and leaves to deal with a pharmacy emergency. It turns out a supplier sent double the number of meds they sent, and Oscar the pharmacy tech can't find the P.O. She tells Oscar to refer it to Gail, who is out sick. As she goes, she wonders if it was Vicodin but confirms it's Ephedrine. She tells Oscar to get Gail in as soon as possible.
As Cuddy goes to meet with her 8:30 appointment, Dr. Hourani calls in with another emergency: House has lowered the temperature in the operating theater to force him out. Cuddy heads for her appointment with Atlantic Net Insurance and House meets her, explaining that his patient needs immediate surgery. Cuddy ignores him, heads for the meeting, gets a call from her sitter Marina that Rachel is running a fever, and then gets another call that her 8:30 appointment is there. She arrives at her office and finds the Atlanticnet representative, Eli Morgan, waiting for her. She asks if he's ready to give ground and refuses to come back to the negotiation table. Cuddy gives him an offer of a 12% increase and Eli refuses. As he goes, Cuddy warns that they're going to terminate the contract. Eli warns that she's bluffing, but Cuddy tells her that he has until 3 p.m. when she's going to make the announcement public.
As Cuddy leaves for her board meeting, House is waiting for her outside. She wonders what he's heard and House explains that he figures either she or Eli made an ultimatum. He hopes that she wasn't bluffing and Cuddy insists that she is. As they head for the elevator, Taub and Thirteen arrive with word on their patient, Mr. Pluta, who is having heart problems and hallucinations. Cuddy refuses to let House infect Pluta with malaria. He starts discussing the case as Cuddy gets away.
As Cuddy arrives at her board meeting, Chief of Surgeon Dr. Dave Thomas is waiting for her and tells her that she can't keep catering to House. He wants Chase back and threatens to quit if she doesn't do her job. Cuddy then talks to the board, and they want to know why they don't have a deal. She explains what she did and that she plans to terminate the contract. One of the members, Sanford, warns they'll lose 80% of their patients but Cuddy insists the insurance company will give in. He says that they can't stop her, but if the negotiations don't work out, she's fired.
In the elevator, alone, Cuddy briefly loses her composure and then heads to the clinic. House hasn't shown up so Cuddy takes on a patient, Hall, who insists he has cancer. He insists he needs human breast mark, which has cancer-fighting qualities. If he can get Cuddy to prescribe it, the insurance company will reimburse him. When she refuses, Hall wonders if she's shilling for the insurance company and points out that it can't hurt him. He begs her to help but she refuses.
Cuddy is still scrambling to fill things in and Nurse Regina warns that there's a lawyer, Ronald Westbrook, in her office. He informs her that he's representing Martin Acevedo, who is suing Chase. Chase reattached Martin's thumb after he cut it off from a table saw, but the client doesn't want it attached. Chase explains that he couldn't just let the man toss it away, so he reattached the thumb without his permission. Cuddy tells him the insurance company is suing so they don't have to pay the $80,000 bill.
Next, Cuddy meets with Gail, who admits that she's was purchasing drugs through the hospital to get weight-loss pills so she wouldn't lose her husband. She begs Cuddy to give her a second chance, and Cuddy agrees not to report the theft. However, she has to fire her despite her perfect record for the last seven years.
Cuddy goes to the cafeteria for lunch, and Wilson tries to reassure her. He doesn't think the board will fire her… until he hears what she did. Cuddy keeps leaving messages for her sitter, and admits that Lucas is avoiding her because he's figured she knows about his bet with House. She asks Wilson what she should do, and Wilson suggests that she should ask House, the master manipulator. She figures it's complicated enough already and goes to her office. House is in her chair, using her computer to browse porn. He needs her signature to treat his patient with malaria, and she realizes that he has a bet to see if he can use malaria as a diagnostic tool. House points out that she's taking a much bigger gamble against the insurance company and leaves.
Lucas arrives with lunch for Cuddy, and she tells him that she knows about the bet. He vows not to do it, and Cuddy demands to know if Rachel is okay. Lucas tells her that the fever has broken and she has a little bit of diaper rash. He tells her to relax but she doesn't. Cuddy dials Marina again and Lucas realizes he grabbed Marina's phone. He also turned off the ringer at home so he could sleep. Lucas offers to find some dirt on Eli and Cuddy gets an idea.
Cuddy goes to a restaurant and finds the CEO of the insurance company, Keith Tannenbaum. She makes his case to him and points out that their profits could fund the hospital for two years. Cuddy warns him that she'll portray him as a rich bastard in the press to put pressure on him, but Tannenbaum is fine with that as long as he's rich.
As Cuddy tries to slip out, Stan, the head of Pharmacology, tells her that ten cases of drugs, $50,000, are missing. She figures Gail is supplying a meth lab and tells Stan to get Gail back in there. Cuddy returns to her office and finds Eli with a new proposal: 8%, up from 4%. Cuddy insists on 12% and Eli warns she's not going to get it.
Cuddy goes to the stairwell for a few minutes to pace nervously. When she comes out, House is waiting for her and tells her that he needs a transplant surgeon. He wants her to get Hourani to perform the operation. She finally breaks down and asks him what he would do. House tells her to stick to the numbers and not worry about what's fair or unfair. She notes he'd risk his job over it, but he points out he's the kind of guy who infects a patient with malaria to win a bet.
It's 3 o'clock and Cuddy goes to the press conference. Everyone is gathered, including House's staff, and she tells them that they'll no longer be accepting patients with Atlanticnet health insurance. The staff breaks into an uproar and demand answers.
Back in her office, Cuddy waits for Marina to call back. Foreman arrives and tells her that House and Thomas are butting heads over having Chase doing the surgery. Only Cuddy can make the final decision. She goes to see House and discovers that he's with a masseuse. Cuddy tells him to get his department under control, but he warns that she has bigger problems and the insurance company isn't going to fold.
Cuddy calls a meeting with Ronald and his client, and Cuddy points out that she still has a thumb. She notes that the insurance won't pay the hospital because of the suit, but she'll cover half of Martin's deductible and help him to refile. When Ronald objects, Cuddy notes that it costs the hospital much more to do the operation. Ronald prepares to walk, and Martin admits that he can't afford to pay. Cuddy reminds him that he has a thumb, and gets a page. She discovers Thomas, Foreman, Hourani, Thomas, and Chase fighting outside the operating theater while House looks on.
After she breaks up the fight, Gail arrives and Cuddy goes to see her. When she says she's calling the DEA, Gail threatens to lie and accuse House and Cuddy of being in on it while having an affair. Cuddy has had enough, says she's quitting, and goes to her car in the parking garage. House finds her and gets in. She admits that House owes Lucas the money on the bet, and he tells her that Hall came to him and he wrote the prescription. House tells her that she's not going to quit because she's too stupid. Cuddy then asks him about Gail, and he admits that he always figured her for a psychopath.
Cuddy gets an idea and asks Gail in, and says she'll do what she can. When she insists that Gail is a good person at heart, Gail says that she started stealing six months after she arrived, and Cuddy is an idiot for not realizing it. She promises to take Cuddy down with her and leaves. After she leaves, Cuddy reveals to Regina that she secretly taped the conversation, and then goes to hand in her resignation. As she goes, Marina finally calls and assures her that Rachel is fine. As she runs for the elevator, Eli comes to her and admits he's surprised that she did it. He tells her that she got her 12% and congratulates her. Cuddy cheers as everyone looks on.
The board and the staff congratulate Cuddy as she gives them the news. House just smiles. As she returns to her office, she discovers that Martin accepted her deal and left her a check for the first installment of the $16,000. She rips it up.
Cuddy goes home and lies in bed with Lucas and Rachel. And House calls again.