Negotiations with commercial insurers

[strike5858]

I will be entering into negotiations soon with commercial insurers in regards to my reimbursements. Any tips or insight? Probably won't have much leverage being right out of fellowship but I am the only fellowship trained pain guy my area, also only one that is anesthesia based who is doing pain. Any way I can use that to help me get a better rate?

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[Aether2000]

lol....good luck with that....

 

[drusso]

I will be entering into negotiations soon with commercial insurers in regards to my reimbursements. Any tips or insight? Probably won't have much leverage being right out of fellowship but I am the only fellowship trained pain guy my area, also only one that is anesthesia based who is doing pain. Any way I can use that to help me get a better rate?

You'll take what they give you and be happy. The insurers don't give a rat's ass about your training, your quality, or your pride. In a sense, they would prefer that the cheaper, lesser trained docs do the work because they won't try to ask to for more money.

 

[nvrsumr]

There are some legit suggestions for negotiating on this forum. Do a search. You probably cannot negotiate but doesn't hurt to ask

 

[hyperalgesia]

I will be entering into negotiations soon with commercial insurers in regards to my reimbursements. Any tips or insight? Probably won't have much leverage being right out of fellowship but I am the only fellowship trained pain guy my area, also only one that is anesthesia based who is doing pain. Any way I can use that to help me get a better rate?

From an insurer's POV, your only leverage is your ability to entice people to buy their insurance plans. If you have 1000 loyal patients who will follow you across insurers, you're in business. If you have a huge market presence in town that all pts want a piece of, that's something.

As a new guy meeting with an established insurer that has built up a base of paying customers, that has lobbied and conspired with the govt to force people onto their plans, it's like David vs Goliath.

 

[jsaul]

I will be entering into negotiations soon with commercial insurers in regards to my reimbursements. Any tips or insight? Probably won't have much leverage being right out of fellowship but I am the only fellowship trained pain guy my area, also only one that is anesthesia based who is doing pain. Any way I can use that to help me get a better rate?

I know someone who just graduated and did the same the you are talking about. There were 2 other pain doctors in the area. One insurance offered 80 percent of medicare rates. One said they have no need for their services. and one did not respond, and the last offered i beleive 75 percent of medicare


so as Algos said-- GOOD LUCK and may the force be with you

 

[Disciple]

Physicians lost this battle a long-time ago.

Better use of time and resources to explore direct pay models, direct contracts with employers, cash pay, and hope that the current deregulatory environment can open up new opportunities. The public and employers are tired of being gouged by hospitals and insurers.

As drusso stated, controlling the means of production is crucial. Give that up, and there goes your leverage.

 

[BobBarker]

Yes employer/self insured “TPA” plans are something to look at very closely.

 

[studentdocg]

If I apply for credentialing but don't like the rates, can I back out? I would assume so but don't want to get stuck.

 

[Biohazard685]

If I apply for credentialing but don't like the rates, can I back out? I would assume so but don't want to get stuck.

Definitely. You're good to go up until you sign a contract.

 

[Biohazard685]

I'm fresh out and struggling to get on panels. Credentialers won't even give me the time of day because I'm in a relatively bad market.

What pisses me off is I know all the physicians on a certain carriers panel and I KNOW none of them are accepting new patients.


Luckily, Medicare doesn't discriminate as bad.

 

[studentdocg]

I'm fresh out and struggling to get on panels. Credentialers won't even give me the time of day because I'm in a relatively bad market.

What pisses me off is I know all the physicians on a certain carriers panel and I KNOW none of them are accepting new patients.


Luckily, Medicare doesn't discriminate as bad.

Does anybody have success with balance billing? And if you do, do you still submit prior authorizations so that the patient has an idea how much stuff will cost? I see several places in my area that leave all out of network insurance discussions up to the patient.

 

[lonelobo]

Look for a local IPA

 

[promethius]

You'll take what they give you and be happy. The insurers don't give a rat's ass about your training, your quality, or your pride. In a sense, they would prefer that the cheaper, lesser trained docs do the work because they won't try to ask to for more money.

What have you got to lose by asking? The worse case scenario is they say no, and you are left with the same rates as you had before. You can then decide whether or not you want to accept their insurance. Unless the contract explicitly states that the rates are non-negotiable, I usually try to negotiate a higher rate. I got one insurer to increase the rate by 5% and another by 10%. Nothing to really write home about, but, as with anything in life, you won't know unless you ask.

 

[deleted185747]

I'm fresh out and struggling to get on panels. Credentialers won't even give me the time of day because I'm in a relatively bad market.

What pisses me off is I know all the physicians on a certain carriers panel and I KNOW none of them are accepting new patients.


Luckily, Medicare doesn't discriminate as bad.

If you can't get on a panel then join up with someone who is on the panel and will give you a fair portion. Example: Lease a room in a chiropractors office, he will send you patients, you see them and bill thru his contract. Do your shots and bill the patient's insurance theu the chiropractors contract. Key is in making sure chiro gives you the money when it comes in.

 

[NJPAIN]

If you can't get on a panel then join up with someone who is on the panel and will give you a fair portion. Example: Lease a room in a chiropractors office, he will send you patients, you see them and bill thru his contract. Do your shots and bill the patient's insurance theu the chiropractors contract. Key is in making sure chiro gives you the money when it comes in.

Like trying to take food from a hungry lion.

 

[Biohazard685]

Like trying to take food from a hungry lion.

There might be situations to exploit. Maybe an interventional radiologist that's on their own and mainly does fistula/dialysis work? I figure many IPM CPT codes and IR CPT codes overlap.

 

[mid|ine]

You might try asking the insurance companies to look at the alternative. If you can't make it on your own, you would likely join a hospital, and the site of service differential is huge. They can pay you well over medicare and its still a bargain for them to have you treat in the office.