Negotiating a Health Plan Contract

Many physicians assume that attempting to negotiate a health plan contract is hopeless — but that is a myth. Practices have been successful in negotiation attempts, winning both payment and term changes in their contracts. The first step in securing a better contract is deciding if you want to contract with the health plan in first place, and if so, how badly. To do this, you need to do some homework.

  • Do the fees paid cover your true costs of doing business?
  • Do you understand how the fees are calculated and the implications for the services you offer?
  • Does the health plan steer patients to you?
  • Are the plan’s administrative requirements reasonable for your practice?
  • Is the health plan crucial to your payer mix?

Only after you have a clear picture of how the contract might play out in your practice can you negotiate effectively to get the terms and fees you need to make it worthwhile — or decide to walk away if you can’t. Any time is a good time to assess contracts but just remember, you can't win if you don't even try.

Have questions? I’m here to help.

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