I started as a solo practice in January 2019 and it's mushroomed to over a dozen providers. Here is what I did.
-took Medicare (pays decent here)
-was lucky enough to be paneled into BCBS without having to take medicaid
-I did take insurances like Optum and accepted their terrible rates, less than $50 per 99213 and less than $50 for a 90833.
-my first year worked my tail off and built up quickly
-once I had a lot of Optum's members under my care but was also established with a panel from other payors, then I negotiated more assertively. I think at that point, they did not want to lose the psychiatric care that was established
-helps to have an idea of what the market rate overall is based on other commercial payors, medicare, cost of living and cost of living adjustments, etc.
-approach the negotiation professionally, in a friendly way, but firm
-insurances want to know how you will help them keep medical costs down. Do you get people in quick? Do you do psychotherapy as well? What about long acting injections? Are you familiar with ECT and how to refer a good candidate? Do you send claims electronically and use ERAs and EFTs to save healthcare costs?
-follow up with insurances regularly about the negotiating thread. Many will ghost you. Keep a recurring reminder on. Follow close but don't be a pest.
-keep records and track of what exactly was agreed on, especially with Optum. Ask for it in writing. Ask for the updated contracts, amendments, and effective dates in writing. Keep track of who you discussed with, when, what was said. I preferred to keep email threads because some of these discussions literally dragged for over 3 years.
-then check your remittances and bank payments to make sure the insurance is actually following through. It's not uncommon for payors to conveniently not increase the payout in the claim system. I usually send one claim first, then see. Once the all clear is there, I send all the other claims.
-and don't forget to keep on: market, market, market. The stronger of a pipeline or referrals you have, the more payors and rates you can choose from. You can be preferential to the better payors. Then the payors who don't treat you as well have to compete for your services.
On first starting, as a solo provider it was very "take it or leave it, you're just one provider." I had to build my worth to the insurance company but the more people they have under your care, the more their stake is in it. imho, optum and cigna are the worst for negotiating with. Your local insurances like the market place ones, the ones based in your state tend to be the BEST. Also, many hospital systems offer their employees a unique insurance that may say, use BCBS as their third party administrator. It's not hard to get contracted with those. Being paneled with say, BCBS will NOT have you in their network, you need to apply for the individual hospital employee insurance contract and often the contract rates will be different and substantially higher than regular BCBS/Aetna/etc. The hospital employee insurances are really really great as they tend to have awesome rates and/or may let you negotiate more. The big national ones like Aetna, Humana, Optum, Cigna are really tough to negotiate with. Especially Optum and Cigna. Local insurances are the way to go and make good connections with hospital system HR departments and Ob/Gyn.
