Skip to main content

Advice for Negotiating with an Insurance Company

May 4, 2017

negotiate payer contracts.jpeg

Unfortunately, there are parts of every job that people would rather leave behind. For many physician practices, this means negotiating with insurance companies. It is no secret that negotiating with different payers can be a major challenge from the time this requires and the revenue implications this entails. For physicians who are looking for ways to either increase reimbursement rates or ensure that bills and claims are paid out as expected, it is important to keep a few negotiating factors in mind.

Don’t Accept a Take it or Leave it Offer

Unfortunately, many physician practices negotiate with insurance companies who use the negotiation strategy of “take it or leave it.” This is a common practice that could leave physician practices feeling like they only have two choices on the table. Remember that there are always other choices. It is fine to come back with a counter offer because the physician practice has something to offer the insurance company. Without the physician practice, the insurance company will not have a place for their patients to go for medical care. If the practice wasn’t valuable to the insurance company, they wouldn’t be at the table. Every insurance company wants to protect their slot in the market and this requires making a deal with the practice. The physician practice has value and can use this value to leverage better deals. Practices merely have to nail down what their value is during the negotiation process. Do not be afraid to come back with counter-offers and do not fall for a “take it or leave it “negotiation strategy.

Talk to the Right Person

Most people know the frustration of spending inordinate amounts of time talking to someone who actually doesn’t have the authority to make any decisions. Regardless of the reason the doctor and the insurance company are talking, make sure that the person on the other end of the line has the authority to make decisions. Unfortunately, this is rarely the first person on the other end of the line. Often, the first person is simply a customer service representative. Physicians need to find a manager, supervisor, or executive who is capable of making decisions. Physicians should focus on finding a provider representative at the company who actually handles their contracts and incentives. This information could be hard to find and this is when those local lobbies and medical societies become useful.

Related Article: Framework for Negotiating Payer Contracts

Those organizations often know who handles the contracts for different areas depending on the insurance provider. It could be helpful to look at the signature of the insurance representative on the prior contract and start by asking for this person. If they’ve been replaced, ask to speak to their replacement.

Bring Data to the Table

Once the right person is on the line, it all comes down to negotiating strategy and driving the best deal possible. This requires bringing data to the table to make the negotiation an objective discussion. The practice should provide data that clearly demonstrates to the insurance company that the practice provides quality care for satisfied patients while containing costs. This will help make the insurance company more comfortable because they know that their patients will have a solid medical home without bankrupting the insurance company or eating away at their profits. The practice also needs to take the time to define how long the contract is good for, any possible reasons for termination, the implications of two separate payers merging with each other, and the timeframe for payments. The practice should prioritize the importance of these factors so that they get what they need most out of the negotiation. Practices need to ensure that all of these details are accounted for. Remember that negotiating is a give and take procedure.


Get the Latest RCM News Delivered

Receive practical tips on medical billing and breaking news on RCM in your inbox.

Get in Touch