Insurance Contract Negotiations

Physicians and organizations need to do everything in their power to collect and keep as much of their money as possible. Most offices have never renegotiated their contracts and very few actually renegotiate them on an annual basis. This simple fact could mean that your office is leaving 10-25% of your collections in the insurance company’s bank. In today’s world, that could be the  difference in you staying in business vs deciding to join a hospital.

In addition to our contract negotiation services, we also offer contract evaluation services to ensure you understand exactly how you are being paid.  Our standard process is to complete a thorough contract evaluation process before beginning any contract negotiation project.  We like to ensure, to the best of our ability, that our negotiation services will be able to obtain a substantial enough increase to your insurance rates to justify the expense.

What’s Included In Our Negotiation Service:

  • Properly review and analyze all current agreements
  • Evaluate your payer agreements and how they compare to regional market standards
  • Propose a contracting strategy based on your goals and the current insurance climate
  • Determine whether captitation, exclusivity, or preferred provider status is available with any payers
  • Consult with payers regarding pay-for-performance measures and what fee schedule works best for the group
  • Determine if you are losing referrals because you’re not participating with certain insurance plans
  • Develop and implement our plan to renegotiate your insurance agreements
  • Provide regular updates as we move through the negotiation process.

How much does it cost to renegotiate my insurance contracts?

Successfully negotiating a payer agreement can take a considerable amount of time which drives the cost up.  This is why we put caps on all of our negotiation projects so you know what the maximum amount of money is that you’ll pay for each contract.  We also work with the payer to quickly determine what level of increase is possible so we know whether or not to proceed.  Most contract negotiation projects cost between $6,000-$10,000 and typically yield at least a 12% increase in your annual collections over 24 months.

How often are we successful?

We are successful over 75% of the time in obtaining increases for our clients which translates into thousands of dollars in additional revenue. When we’re unsuccessful, you pay a fraction of our actual cost.  We want to be successful as badly as you do and will only take on your project if we feel like there’s a high probability of success.  With the current economy, insurance companies are tightening up so it is important that you lean on experts who are well versed in contracting strategies. Insurance companies will never ask you if you would like to be paid more so it is up to you to seek this out. If you have tried in the past but have been unsuccessful, it is most likely due to the absence of key relationships within these organizations. We have the relationships and tools necessary to provide you with quantifiable results that directly impact your bottom line.

What kind of an increase can I expect?

Successfully renegotiating your insurance contracts typically yields a 10-12% increase over a 1-3 year period.  This is money that is available to nearly every office but is lost because most offices do not have the time or expertise required to successfully renegotiate their payer contracts. If you do not remember the last time your contracts were negotiated, then this a service that you cannot afford to pass up.

Should I negotiate my insurance contracts?

If you elect to renegotiate them yourselves, remember that most insurance companies will only provide you with the increase that is due for the current year (2-5%). If you want more, you need to have the tools that will illuminate the added value your organization provides to their members. Remember that you are providing a valuable service to their organization and it is important that you remind them of this often forgotten fact. In light of the Affordable Care Act and the increased competition among insurance companies, everyone is scrambling to provide more value and service to their members.  The value they are most often “finding” is through cutting reimbursements for providers and reducing the member’s premium expense.  Every penny really does matter to the payers now that customers have the ability to evaluate plan options and price through the exchange.  You have to be the group that they do not want to lose, how you show them this will require some skill.


Find out what your practice is losing in revenue by not negotiating your contracts. Let our analysts tell you by completing this short questionnaire. We will equip you with the information so you know what to expect when negotiating your contracts. If you feel that you do not have the time to conduct a thorough evaluation and renegotiation, we would be happy to provide you with a quote for our specialized services.

Read more about our Contract Renegotiation Services Here or watch our video on evaluating your insurance contracts below

Insurance Contract Evaluation Video