We hear questions from our clients all the time regarding whether they can or cannot negotiate fees with insurance companies. The answer to that question is an absolute…..maybe. Factors such as the location of the practice, the amount of time since the last fee increase, the number of equivalent providers or specialists in network in the area, and even the economic climate of the local area can have an effect on your negotiating success. That being said, never hesitate to ask if you can negotiate the fee schedule and always be persistent. If the first round of fee suggestions the insurance company presents seems too low, counter with higher numbers and see what they’ll do. Obviously a more mature office will have better luck at this, but we’ve seen specialty offices get a significant fee increase by repeated negotiation. Also, be sure to ask about the fees before you sign on the preferred provider dotted line…..while you still have leverage in your court.
In regard to insurance filing, you also want to be sure to always submit your full fees to the insurance company. Most current software has a provision that allows you to do so, while still posting the expected insurance amount to the patient ledger. There are two reasons why this is a good idea. First, when insurance companies review their fee schedules, the submitted fees by doctors in the area are one of the pieces they consider to decide whether to raise what they consider reasonable and customary. The other reason is that once they do decide on a fee increase, it often takes a while for them to get the new fees to you, and it may take a while for your staff to enter them into the software. These delays can mean a loss of revenue for the practice while you’re still submitting the lower fees.
