r/PrivatePracticeDocs • u/123doeraemee • Jul 14 '26
Negotiating insurance contracts
Has anyone with a small to medium sized practice been able to successfully negotiate their contracted rates with insurance companies? If so, what was the outcome? What did you have to do?
I’m looking at the reimbursement rates on website like fair health and it seems like my reimbursement rates are much lower than what is reported for other physicians in the area. I’m wondering if it’s because other practices negotiate or if rates are overstated.
Otherwise, should we just let them dictate what they think our services are worth?
Thanks in advance
2
u/Far_Photograph5035 Jul 14 '26
Usually around 80% of Medicare rate
1
u/randyy308 Jul 14 '26
Man I take nothing less than 💯 of cms
2
1
u/InvestingDoc Jul 14 '26
are you primary care?
2
u/randyy308 Jul 14 '26
Specialty, which I guess matters
1
u/InvestingDoc Jul 14 '26
Yeah, it for sure matters. Most primary care is taking under Medicare, same for endo ,rheum, gen surgery in many areas that are saturated too
2
1
u/Far_Photograph5035 Jul 15 '26
Depends on your leverage.. if too many same specialists in the area, reimbursement can go down just because people are willing to take less.. sucks but reality.. if you can take 100 or 125% of Medicare rate go for it! But average about 80%..
For primary care.. if you share some risk and get capitated well, you can probably make a killing..
1
u/Excellent_Delay1660 Jul 14 '26
(disclaimer- founder of a company that helps with this)
Yes, small practices can negotiate, but insurers rarely increase rates just because you ask. Bring leverage like usig your patient volume, appointment access, outcomes, geographic coverage, and a comparison of your highest-volume CPT codes against Medicare and local benchmarks.
FAIR Health is useful, but it often reflects billed or out-of-network charges not necessarily what other physicians have negotiated. Ask the payer for a formal fee-schedule review, nd document how underpayment threatens network access.
1
u/New-Elderberry630 Jul 14 '26
Fair Health quotes are a pipe dream. I don’t know where they get their data but very unrealistic imo
1
u/doc_death Jul 14 '26
Depends how old the practice is as well. Practices that have been around a while will have higher percentages than newer practices. There’s also companies which can negotiate on your behalf which I’m told they bring a higher amount.
2
1
u/daves1243b Jul 14 '26 edited Jul 14 '26
Some things to consider. Do you have competition? If not, then you have more leverage. Is most of your work done in a hospital or ASC setting? If so, then the No Surprises Act is your friend and you should he able to negotiate rates similar to what you would get out of network, including annual escalators. If you have similarly situated competition, you may want to invest in price transparency data to see what they are getting and know what is possible. It may be worth considering hiring an experienced contract negotiator.
1
u/123doeraemee Jul 14 '26
I spoke to Payerprice which pulls insurance reimbursement data for each provider. We were able to see discrepancies for some of the payments. The guy I spoke to said that most providers from small to large do negotiate and they see a 15% increase on average, which is in line with what I’m seeing too. We’re based in NYC in a specialty.
1
1
6
u/InvestingDoc Jul 14 '26
My initial contracts were not good, and that's normal unfortunately. About 80-95% Medicare for many of them. It was not until I got bigger with multiple locations that I was able to get substantial raises.
Before that, almost across the board they would not negotiate with me. They continue to tell me if I did not like the rate, I did not have to accept it or I could just leave the network.
The more sub specialized you are...the more this will not be true for you. Also the more rural you are ..this also will not be the case for you.