Unhappy unless in Private Practice?

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It used to be so much worse before CAQH. So not crazy amounts, just annoying amounts. Combine that with the most likely pain of doing CAQH for the first time, trying to graduate, finding a place for your business, yada yada yada...
 
daru1 said:
It used to be so much worse before CAQH. So not crazy amounts, just annoying amounts. Combine that with the most likely pain of doing CAQH for the first time, trying to graduate, finding a place for your business, yada yada yada...
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Thanks for the clarification. Is workman's comp known to be a good payer? I looked at their fee schedule for my state and it was about 50% higher for all the typical E/M codes based on the medicare rates ? Insurance paying almost 150 for a 99214 i thought there must be some catch. Then of course i get the fee rates from another priv insurance who says no one has ever complained about their rates only to find they are 12-15% lower than of medicare. Perhaps i'll ask if these are negotiable and get a "best rate" in the area like you did. Oh the games these people play.
 
Just remember that there is a shortage of psychiatrists. Unless you are in a rural area/NYC/Cali, you can easily build a practice with just the better paying insurances if not cash-only. Do not settle. We have the upper hand. Our problem is not knowing what to do while in the seat of power.
 
TexasPhysician said:
Just remember that there is a shortage of psychiatrists. Unless you are in a rural area/NYC/Cali, you can easily build a practice with just the better paying insurances if not cash-only. Do not settle. We have the upper hand. Our problem is not knowing what to do while in the seat of power.
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thank you for the confidence. It sounds like you really know how to hold your ground when dealing with private insurance paneling. What kind of fee standards do you keep with insurance companies? Not asking for specifics other than are you often successful to them agreeing to at least medicare rates in your area?
 
finalpsychyear said:
thank you for the confidence. It sounds like you really know how to hold your ground when dealing with private insurance paneling. What kind of fee standards do you keep with insurance companies? Not asking for specifics other than are you often successful to them agreeing to at least medicare rates in your area?
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If the initial offer is below Medicare rates, I'm not sure they are worth our time. You don't need to accept many insurances to have a thriving practice.

The common fear is that a practice will fail, but this is incredibly rare and usually due to a poor business model. With this mentality, many accept many insurances as a fail safe. Don't.

The patients will come. Keep costs down and live frugally. The beginning (new evals) pay less than follow-ups. It will be rocky.

The psychiatrists that stress and accept the low paying insurances will often be flooded by these low paying insurance patients due to other providers not accepting it. This is a problem as you spend more time getting paid less. As your wait list grows, the better paying insurance patients look elsewhere. You end up with a long-term problem.

Ideally, we are in this for the long-run. Set yourself up for success from the beginning.
 
TexasPhysician said:
If the initial offer is below Medicare rates, I'm not sure they are worth our time. You don't need to accept many insurances to have a thriving practice.

The common fear is that a practice will fail, but this is incredibly rare and usually due to a poor business model. With this mentality, many accept many insurances as a fail safe. Don't.

The patients will come. Keep costs down and live frugally. The beginning (new evals) pay less than follow-ups. It will be rocky.

The psychiatrists that stress and accept the low paying insurances will often be flooded by these low paying insurance patients due to other providers not accepting it. This is a problem as you spend more time getting paid less. As your wait list grows, the better paying insurance patients look elsewhere. You end up with a long-term problem.

Ideally, we are in this for the long-run. Set yourself up for success from the beginning.
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Damn, this is excellent advice. I really didn't think of it in this way. I wish i had more advisors with your experience . One told me to apply to the 10-12 "big name insurers" in my area( 60k population with somewhere around 7 total psychiatrists so not sure if that is considered a shortage area), review the rates and then only accept 3-4 of them. Another said to just be on several and have some type of "tiered" system for giving appointments to the best insurances first and put the other ones on a waiting list and use that list for weeks when it is slow. This PP attending i shadowed had a "medicaid" list of new patients that would get appts when his follow ups would cancel a day or two before there date. Not sure the ethics of all that would sit well with me though although from a business perspective it seemed to work for him.

Regardless, I'm so excited to start this process. :soexcited:

And very thankful to have such wonderful people on this forum (even vistaril is back).. :claps:
 
finalpsychyear said:
Another said to just be on several and have some type of "tiered" system for giving appointments to the best insurances first and put the other ones on a waiting list and use that list for weeks when it is slow.
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I honestly thought about doing this when I started, but then saw how many patients called my clinic within the first month for new patient appointments -- and me only accepting one insurance -- the decision to not bend ethics was easy at that point. Just like was said above, don't let the fear of a sluggish or failing practice get to you. It's very rare. 7-8 psychiatrists per 60k people isn't too bad of a ratio, you can still be competitive.
 
Scheduling appointments based on which insurance someone has could get you in trouble especially if the government ones are lower priority and someone complains. I don't think you want them breathing down your neck. Texas physician has it right. Use smart business strategies to fill your schedule with higher paying, low no-show patients. Also, factor in headaches with insurers such as pre-auths and limitations on visits. Some require doc to call, with others it can be office staff.
 
Wow I am truly shocked at how the 4 private companies that have given me fee schedules are all under medicare rates. I legally can't of course identify the companies although i haven't signed any contract with anyone so not sure im under obligation?... but this is what i have seen so far for my area:

1. Medicare 99213: $70 99214: $103

2. Priv insur #1 $60 $90

3.Priv insur #2 $50 $79

4.Priv insur #3 $59 $79

5.Priv insur #4 $43 $66 ( stated they pay medicaid rates only)



Here i was ready to reject the first one paying under medicare and now this.... can't believe they can low ball like this.:sendoff:
 
finalpsychyear said:
Wow I am truly shocked at how the 4 private companies that have given me fee schedules are all under medicare rates. I legally can't of course identify the companies although i haven't signed any contract with anyone so not sure im under obligation?... but this is what i have seen so far for my area:

1. Medicare 99213: $70 99214: $103

2. Priv insur #1 $60 $90

3.Priv insur #2 $50 $79

4.Priv insur #3 $59 $79

5.Priv insur #4 $43 $66 ( stated they pay medicaid rates only)



Here i was ready to reject the first one paying under medicare and now this.... can't believe they can low ball like this.:sendoff:
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Got some work to do in negotiating better rates!
 
Shikima said:
Got some work to do in negotiating better rates!
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What exactly have you done that has worked? ex: writing an email stating that your quoted rates are almost 10-15% below the medicare rates for the area?
I reached out to these companies while others have said certain insurances reached out to them. Not sure if that matters. I am also a one man show.
 
finalpsychyear said:
What exactly have you done that has worked? ex: writing an email stating that your quoted rates are almost 10-15% below the medicare rates for the area?
I reached out to these companies while others have said certain insurances reached out to them. Not sure if that matters. I am also a one man show.
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That's all you can do and cite the number of physicians in the area and you can quote shortage statistics if you'd like.
 
finalpsychyear said:
What exactly have you done that has worked? ex: writing an email stating that your quoted rates are almost 10-15% below the medicare rates for the area?
I reached out to these companies while others have said certain insurances reached out to them. Not sure if that matters. I am also a one man show.
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They already know that their rates are lower than Medicare and even if they didn't why would they care? Why not just tell them the rate that you want and see what they say? That is the way to negotiate. It is your turn to counter. I haven't actually done this as my employer negotiates our rates and generally does it fairly well so take my advice with a grain of salt. Having providers on their panel does keep their customers happy so they have some motivation to get you on there.
 
Wow. You guys were right. I actually just asked more about rates and now they are offering above medicare. N = 1. Kind of infuriated as i can imagine a lot of psychiatrists just agreeing off the bat. Sleezy move by insurance companies. She quoted in her email " you are catching on".... Not sure how it will go with the other few though. Fingers crossed

A big thank you to DARU1, SHIKIMA, and TEXASPHYSICIAN for giving me confidence!
 
I'm also in an area where the main private insurers have rates which are not only below medicare rates, they are FAR below medicare rates. In fact in some cases below medicaid rates(but you can get a little more overall because you can add a 90833 which you cant do for medicaid depending on clinic setup).

Medicare rates here are lower as well than the numbers seen above. I wish I could get Blue Cross to pay me a hundred dollars for a 99214 alone hehe........It's more like(and I don't have the exact chart in front of me) 52 for the 99214 and then like 30 for the 90833 if I can combine the two. I know I can make low 80s in reimbursement for the two combined. Some of the insurers, depending on the plan, or wanting prior authorizations before the visits where a 99214 + 90833 is being billed together though. I don't bill anything to blue cross less than 99214 because the 99213 pays like 37 dollars. **** that.

I think some of these plans involve MH carve outs.....oh well it is what it is. And no you can't 'just negotiate'.
 
vistaril said:
I'm also in an area where the main private insurers have rates which are not only below medicare rates, they are FAR below medicare rates. In fact in some cases below medicaid rates(but you can get a little more overall because you can add a 90833 which you cant do for medicaid depending on clinic setup).

Medicare rates here are lower as well than the numbers seen above. I wish I could get Blue Cross to pay me a hundred dollars for a 99214 alone hehe........It's more like(and I don't have the exact chart in front of me) 52 for the 99214 and then like 30 for the 90833 if I can combine the two. I know I can make low 80s in reimbursement for the two combined. Some of the insurers, depending on the plan, or wanting prior authorizations before the visits where a 99214 + 90833 is being billed together though. I don't bill anything to blue cross less than 99214 because the 99213 pays like 37 dollars. **** that.

I think some of these plans involve MH carve outs.....oh well it is what it is. And no you can't 'just negotiate'.
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1.I appreciate your comments. I am in shock to hear private insurers paying LESS than MEDICAID. In my area it is 43/66/28 for a medicaid level 3,4,90833 respectively. Im quoting midwest rates about 2 hrs from the closest "large" city. I don't know if that plays a factor in this. Around 6-7 psychiatrists in an area of 60-70k people.

2. You stated "(but you can get a little more overall because you can add a 90833 which you cant do for medicaid depending on clinic setup)"
Do you mean in the case for those running strictly a med management practice where its not cost effective if you have a lot of these patients?

3. Preautho for E/M and therapy? I've been told to be careful of 99214+90836 and to not consistently bill anyone 99214 even if it meets MDM, time, etc. I think 99213+therapy is safe. I think if your also seeing meds/therapy q2 weeks to 1x month that will be less challenged/flagged for audits or Utilization reviews.

4. Another insurance carrier i emailed said they would get back to me when i pointed out the discrepancy of 20-25% below medicare rates in their fee schedule. Does negotiating prior to ever being on their panel have more leverage than already being on a carrier and trying to up rates... only you guys can tell me.

5. Are you in a major city with a good supply of mental health providers? Not sure if that is why rates are lower.

I literally still can't get over this woman telling me earlier this week that they pay very well and i would be happy with their rates and providers never raise issues with their payments. I then point out what she emailed me was 15% below medicare rates, she not only gave me a new schedule over medicare but stated " your catching on quickly" in her response... Truly irked me
 
finalpsychyear said:
4. Another insurance carrier i emailed said they would get back to me when i pointed out the discrepancy of 20-25% below medicare rates in their fee schedule. Does negotiating prior to ever being on their panel have more leverage than already being on a carrier and trying to up rates... only you guys can tell me.

I literally still can't get over this woman telling me earlier this week that they pay very well and i would be happy with their rates and providers never raise issues with their payments. I then point out what she emailed me was 15% below medicare rates, she not only gave me a new schedule over medicare but stated " your catching on quickly" in her response... Truly irked me
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You're negotiating a business deal. Their incentive is to pay as little as possible, your incentive is to ask for as much as possible. I don't think the lady is being malicious, it's just how her job works. My understanding is that rates can be renegotiated on a certain basis, probably also stipulated in the contracts that you're currently negotiating.
 
finalpsychyear said:
1.I appreciate your comments. I am in shock to hear private insurers paying LESS than MEDICAID.
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While it very well may be true (how would I know?), you should be warned that Vistaril has been on this site for a number of years now and there may be things about him you don't know. He consistently looks for the worst in psychiatry. He has also flat out lied about things before in order to bolster his arguments. So again, what he said could be true, but there's also good reason to believe it isn't.
 
Shikima said:
Unlikely, Counter with 15% above Medicare citing that the Government is a better payor.
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Now that i have called out one insurance from paying 85% of medicare to 110% medicare just by asking for a simple is that your best rate I don't know if that is where i stop. I feel like i can't trust them. The business man in me thinks should i ask for 120% and settle for something in the middle like 115%... i am fairly new to this so i really have no clue as i've been more angry that i need to almost bargain in a way.. like im on ebay or something. Do you settle or is there more wiggle room in your experience doing this?
 
vistaril said:
I think some of these plans involve MH carve outs.....oh well it is what it is. And no you can't 'just negotiate'.
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Yes you can negotiate - even if they say that they aren't willing to negotiate. MHSA, Magellan, Beacon will negotiate depending on the area. If they don't, then you close off your panel to that insurance. Ultimately, if they need you, they will pay to keep you on their panel.

I've negotiated two contracts with payors who explicitly stated that they are not open to negotiations.
 
finalpsychyear said:
Now that i have called out one insurance from paying 85% of medicare to 110% medicare just by asking for a simple is that your best rate I don't know if that is where i stop. I feel like i can't trust them. The business man in me thinks should i ask for 120% and settle for something in the middle like 115%... i am fairly new to this so i really have no clue as i've been more angry that i need to almost bargain in a way.. like im on ebay or something. Do you settle or is there more wiggle room in your experience doing this?
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Counter with another offer that reflects the higher rate and ask them if they'd consider this rate for services. Be sure you'll be comfortable with that rate.
 
jettavr6 said:
Yes you can negotiate - even if they say that they aren't willing to negotiate. MHSA, Magellan, Beacon will negotiate depending on the area. If they don't, then you close off your panel to that insurance. Ultimately, if they need you, they will pay to keep you on their panel.

I've negotiated two contracts with payors who explicitly stated that they are not open to negotiations.
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So in my area anthem is offering 10-15% below medicare when i asked them to send the rates for their contract. I haven't signed or agreed to anything at this point. I pointed out after reviewing their initial fee schedule they were below medicare by 10-15% and if that was their best rates.
Here is their response: (keep in my mind my area is about 60-70k population with around 6-7 psychiatrists.)


"Anthem feels that providers are paid fairly. The Anthem fee schedule is based on a proprietary schedule—using CMS, UCR and supply and demand. Anthem represents Employer groups and their premium is what directly funds the facility and provider fee schedule. At this time, I don’t have any further suggestions and have been advised by the Network Contractor of the above statement.


If you would like to continue with the Anthem Contract process, I will need a current W-9 form.


If you have further questions, please contact me."

Would you kindly refuse the offer and say something like if future rates become more compeittive with medicare please dont hesistate to contact me?

Thanks to all you balla negotiators. It is is still weird for me but i hope this is how the game is played. I have much to learn from those with experience and am very grateful for everyones contributions.
 
finalpsychyear said:
So in my area anthem is offering 10-15% below medicare when i asked them to send the rates for their contract. I haven't signed or agreed to anything at this point. I pointed out after reviewing their initial fee schedule they were below medicare by 10-15% and if that was their best rates.
Here is their response: (keep in my mind my area is about 60-70k population with around 6-7 psychiatrists.)


"Anthem feels that providers are paid fairly. The Anthem fee schedule is based on a proprietary schedule—using CMS, UCR and supply and demand. Anthem represents Employer groups and their premium is what directly funds the facility and provider fee schedule. At this time, I don’t have any further suggestions and have been advised by the Network Contractor of the above statement.


If you would like to continue with the Anthem Contract process, I will need a current W-9 form.


If you have further questions, please contact me."

Would you kindly refuse the offer and say something like if future rates become more compeittive with medicare please dont hesistate to contact me?

Thanks to all you balla negotiators. It is is still weird for me but i hope this is how the game is played. I have much to learn from those with experience and am very grateful for everyones contributions.
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If they won't negotiate above Medicare, then it's not worth it. They can find someone else to do their dirty work.
 
Shikima said:
If they won't negotiate above Medicare, then it's not worth it. They can find someone else to do their dirty work.
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So much yes to this. I ended up sending in a credentialing packet today that said explicitly "We do not negotiate rates." I guess they lost that round with me 😛
 
Shikima said:
If they won't negotiate above Medicare, then it's not worth it. They can find someone else to do their dirty work.
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daru1 said:
So much yes to this. I ended up sending in a credentialing packet today that said explicitly "We do not negotiate rates." I guess they lost that round with me 😛
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Thanks for all the support. Out of curiosity how many panels do you guys have that are paying above medicare?
Your able to have a full time (60-80 pts/wk) PP based on just those panels?
 
finalpsychyear said:
Thanks for all the support. Out of curiosity how many panels do you guys have that are paying above medicare?
Your able to have a full time (60-80 pts/wk) PP based on just those panels?
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In most areas, everyone will pay above Medicare if they want an additional physician on their panel. It doesn't take any panels to fill in many regions (cash only).
 
finalpsychyear said:
Thanks for all the support. Out of curiosity how many panels do you guys have that are paying above medicare?
Your able to have a full time (60-80 pts/wk) PP based on just those panels?
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Most of my panels pay above medicare, some match it, and a few are below it. Keep in mind that an intake may be above medicare rates, while follow ups are slightly below. A Medicaid panel offered me 150% of Medicare rates, and I turned them down.

One of the largest HMO's in my area called my office asking if I would take on one of their patients, on a per patient contract, for 120%. I turned this one down also.
 
jettavr6 said:
Most of my panels pay above medicare, some match it, and a few are below it. Keep in mind that an intake may be above medicare rates, while follow ups are slightly below. A Medicaid panel offered me 150% of Medicare rates, and I turned them down.

One of the largest HMO's in my area called my office asking if I would take on one of their patients, on a per patient contract, for 120%. I turned this one down also.
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1.What percentage of panels that you eventually got to pay at or higher than medicare did you have to negotiate or were you just in an area where they offered that to start with?

2.When insurances have told you they can't negotiate rates have you refused to panel with them only to have them magically come back with improved rates? wondering if this is another tactic by them or it is a 50/50 move that can go either way. I figured if they didn't need you they would have closed their panel.

Thanks as always. No one in my residency has any idea about this aspect of private practice. I asked they said "no clue, sorry." Even the few recent graduates i went and talked to doing PP said nothing about negotiating.
 
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finalpsychyear said:
1.What percentage of panels that you eventually got to pay at or higher than medicare did you have to negotiate or were you just in an area where they offered that to start with?

2.When insurances have told you they can't negotiate rates have you refused to panel with them only to have them magically come back with improved rates? wondering if this is another tactic by them or it is a 50/50 move that can go either way. I figured if they didn't need you they would have closed their panel.

Thanks as always. No one in my residency has any idea about this aspect of private practice. I asked they said no clue sorry.
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That's one of the issues with medical school and residency, the amount of institutionalized people. Basic classes in business and billing need to be part of the curriculum.
 
finalpsychyear said:
1.What percentage of panels that you eventually got to pay at or higher than medicare did you have to negotiate or were you just in an area where they offered that to start with?

2.When insurances have told you they can't negotiate rates have you refused to panel with them only to have them magically come back with improved rates? wondering if this is another tactic by them or it is a 50/50 move that can go either way. I figured if they didn't need you they would have closed their panel.

Thanks as always. No one in my residency has any idea about this aspect of private practice. I asked they said "no clue, sorry." Even the few recent graduates i went and talked to doing PP said nothing about negotiating.
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I just looked at my contracts, and all of my contracts pay above medicare for the initial, and 80% pay above medicare for the follow ups. From what I recall, 50% of the payors were willing to negotiate in some fashion. A few of these initially said no, but came back later and negotiated. One I tried to negotiate with and we couldn't come to an agreement.

Be careful with Value options, Beacon, Magellan and some of these third party payors. Do not take a ****ty insurance for you will be inundated with tons of low revenue patients. Those who have good insurance will find someone else.

The most important point to remember is very basic: Insurance is in the business to collect money, and keep as much of it as they can without having to pay out. They will talk about "fair compensation," and you will reject this. Your goal is to be paid as much as you can.
 
jettavr6 said:
I just looked at my contracts, and all of my contracts pay above medicare for the initial, and 80% pay above medicare for the follow ups. From what I recall, 50% of the payors were willing to negotiate in some fashion. A few of these initially said no, but came back later and negotiated. One I tried to negotiate with and we couldn't come to an agreement.

Be careful with Value options, Beacon, Magellan and some of these third party payors. Do not take a ****ty insurance for you will be inundated with tons of low revenue patients. Those who have good insurance will find someone else.

The most important point to remember is very basic: Insurance is in the business to collect money, and keep as much of it as they can without having to pay out. They will talk about "fair compensation," and you will reject this. Your goal is to be paid as much as you can.
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Thank you very much for this. I am very impressed with your negotiation skills. I asked anthem if this was there best available rates after i asked and received a fee schedule and the lady got back to me about how she talked to the network contractor and said "anthem feels providers are paid fairly" just like you said (full response from anthem in post #74 above) and then they listed a paragraph of reasons. Then ended by saying to attach my w-9 if i'd like to continue the contract process. This almost says to me they are willing to negotiate but are playing hardball otherwise a simple "no we are unable to do so at this time" answer would have sufficed. Maybe i'm reading more into it than i should.

Part of me wanted to go into a tirade about psychiatrists being in very limited supplies and the ever growing need of mental health etc as I kindly rejected continuing the process until at a later time higher fees become available. Figured waiting a day or so shows less desperation.

My question is should i avoid justifying reasons why i should be offered higher or is just a simple thank you but I am unable to agree to 10-15% below medicare rates more effective ? This is my last question for this weekend. I have asked a lot out of this board and I will give everyone some R and R to hopefully enjoy warmer weather this weekend! Again, I greatly appreciate everyone's efforts and sage knowledge and i hope to pass on whatever i learn to others. I am a dry sponge here.:help:
 
finalpsychyear said:
My question is should i avoid justifying reasons why i should be offered higher or is just a simple thank you but I am unable to agree to 10-15% below medicare rates more effective ? This is my last question for this weekend. I have asked a lot out of this board and I will give everyone some R and R to hopefully enjoy warmer weather this weekend! Again, I greatly appreciate everyone's efforts and sage knowledge and i hope to pass on whatever i learn to others. I am a dry sponge here.:help:
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If it is your first year, ask for 105-107% of medicare. Once your practice gets busy, which it will, then you may be able to bargain for a higher rate or just drop them. Contracting your billing to a good and dedicated company that has a good record of collections will pay off handsomely. Many of them will handle your contracting and assist in negotiation. This frees up your time to concentrate on more important things like marketing.

Addendum: No tirade - they don't care. Always keep in mind that they don't care about the health of their clients. Their clients are only a number with an actuarial figure attached to their heads. The only thing they care about is how much they have to "lose" per premium paying client. Always collect copays and deductibles, otherwise you may see a patient for months and never get paid.
 
finalpsychyear said:
I asked anthem if this was there best available rates after i asked and received a fee schedule
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Is this how you negotiate? I've never done this, but I know that in negotiating other things you can name a number instead of playing games with them. You don't have to justify it either -- everyone knows this is a business and both sides want to maximize profits. So ask them for what you want and don't accept less.
 
hamstergang said:
Is this how you negotiate? I've never done this, but I know that in negotiating other things you can name a number instead of playing games with them. You don't have to justify it either -- everyone knows this is a business and both sides want to maximize profits. So ask them for what you want and don't accept less.
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Negotiate with a multiplier of Medicare. They offer 90%, you ask for anywhere between 105-120%. In some cases, and depending on your area, you may be able to get upwards of 150%, but this is rare. If you've reached a number at least above medicare, there are other things in the contract that you can negotiate to make it more favorable to you.

Remember - this is a business. DONT get emotional. They don't care about patients - they only care about minimizing their payout.
 
hamstergang said:
Is this how you negotiate? I've never done this, but I know that in negotiating other things you can name a number instead of playing games with them. You don't have to justify it either -- everyone knows this is a business and both sides want to maximize profits. So ask them for what you want and don't accept less.
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Dont use me for an example. I've used this exact phrasing twice so far. First time, thats all i needed to say to get a a way higher fee rate sent to me in a few hours. Once i got this then i named an actual rate percentage above medicare. Im hoping they settle somewhere between or worst case scenario still higher than medicare.

The second time i asked this i got a vague answer about they feel its a "good amount" based on xyz and a long winded answer. I have yet to respond to this but likely will call their bluff.A few others said they would get back to me so we'll see how that goes.

Regardless, all the credit goes to the advice from texasphysician, daru1, shikima, jettavr6, and doing the opposite of whatever Vistaril suggested.
 
jettavr6 said:
Negotiate with a multiplier of Medicare. They offer 90%, you ask for anywhere between 105-120%. In some cases, and depending on your area, you may be able to get upwards of 150%, but this is rare. If you've reached a number at least above medicare, there are other things in the contract that you can negotiate to make it more favorable to you.

Remember - this is a business. DONT get emotional. They don't care about patients - they only care about minimizing their payout.
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1.So that same company that initially offered me 110% medicare i countered with 130% and then after 10 days of no response they emailed me a final offer of 120% which is what i was looking for and i am feeling great about this!

2. Anthem who i threatened to walk away from said i would be on their out of network list or something par related but could not offer higher rates. Not sure if they will contact me back. Their new patient codes were actually above medicare for 90792 but a few dollars below for 99213 ( 67 vs 70), 99214 (83 vs 103). This so far has been better than others intial rates. I can always crawl back to them but I'll wait it out after seeing more responses from others.

Again, thanks again for the help. Thought I'd update as I go along.
 
jettavr6 said:
Negotiate with a multiplier of Medicare. They offer 90%, you ask for anywhere between 105-120%. In some cases, and depending on your area, you may be able to get upwards of 150%, but this is rare. If you've reached a number at least above medicare, there are other things in the contract that you can negotiate to make it more favorable to you.

Remember - this is a business. DONT get emotional. They don't care about patients - they only care about minimizing their payout.
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So far I have only had two insurance carriers offering more than medicare. One is a private company that is not a major name and the other is the workers comp for my state which pays 150% of medicare rates:

1. Are the 3-4 panels you have paying more than medicare smaller private insurers or major carriers (aetna, anthem, cigna, humana etc)

2. did you have to be on their panel for a year or two before you got those rates or right from the gates.. cigna told me they are not negotiating but will consider it after 24 months?

3. Can you fill an entire practice with medicare and workers comp? I dont know anything about workers comp but it seems like I would be one of 2 psychiatrists in the entire area on their panel... something seems off here?

Thats it for me and again i thank you in advance for all your help you have given along with everyone else on this forum.
 
LNI pay very well in my state so i am sure some places it would. here 99205 is $350, 99214 is $184, 99213 is $124 +90833 is $110, 90837 (60 min psychotherapy) is $213
 
finalpsychyear said:
So far I have only had two insurance carriers offering more than medicare. One is a private company that is not a major name and the other is the workers comp for my state which pays 150% of medicare rates:
.
Click to expand...

here the average 99214 pays about 50 dollars....some insurers a little more, some a little less. Thats why when I was in private practice I attached a 90833 to literally *every* 99214....to bring the total compensation up to 75-85 dollars per encounter.
 
vistaril said:
here the average 99214 pays about 50 dollars....some insurers a little more, some a little less. Thats why when I was in private practice I attached a 90833 to literally *every* 99214....to bring the total compensation up to 75-85 dollars per encounter.
Click to expand...

How long were your visits then to do this?
What exactly has to be in an encounter other than the 16 min rule to justify a 90833.. just "supportive therapy"?

I'm not promoting fraud or anything but my supervisor said more PP should use these add on codes 90833 and 90836 to "stick" it to insurance companies for their paltry rates. Somehow they want to maximize their profits by minimizing ours. Although, he says with medicare/medicaid he would make sure everything is 100% by the book.

Just got an ofer from optum (aka united health care)... They were paying less than medicaid rates for EM visits for the area... disgusting.
 
finalpsychyear said:
How long were your visits then to do this?
What exactly has to be in an encounter other than the 16 min rule to justify a 90833.. just "supportive therapy"?

I'm not promoting fraud or anything but my supervisor said more PP should use these add on codes 90833 and 90836 to "stick" it to insurance companies for their paltry rates. Somehow they want to maximize their profits by minimizing ours. Although, he says with medicare/medicaid he would make sure everything is 100% by the book.

Just got an ofer from optum (aka united health care)... They were paying less than medicaid rates for EM visits for the area... disgusting.
Click to expand...

More likely than not, once you signed up for 1 big panel you'll see very soon what's going on. If you are marketing appropriately, you'll soon get patients both in ant out of network. Soon enough you'll realize that it's not economical to take a lot of in-network patients, and eventually decide to drop out.

I was very stressed out when I was in your position as well, but nationwide the shortage is so severe that you really don't need to take insurance anywhere. You can drop your out-of-network fee to $125 per visit for 99213+90833, and say $200 for 99213+90836, and people will come and pay, especially if it's once a month, and you'll still net more and less overhead than if you go in-network.
 
vistaril said:
here the average 99214 pays about 50 dollars....some insurers a little more, some a little less. Thats why when I was in private practice I attached a 90833 to literally *every* 99214....to bring the total compensation up to 75-85 dollars per encounter.
Click to expand...

Terrible. I get double that without the add-on.
 
splik said:
here one of the main insurances we take pays triple without the add on ($151 for 99214, would be $220 for 99213+90833)
Click to expand...

are you in a group PP or hospital based outpatient PP to get these types of rates negotiated?
Is the location in a major city?
As a fourth year resident how are you finding out what the billing deparment is actually getting paid as opposed to just how much they are billing?
 
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