Wiki Insurance Contracts

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Texascoder64

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My group practice is using a company that handles our insurance contracting this company is an IPA which contracts us with the major commercial carriers (Aetna, BCBS, Cigna, UHC and so on..) There is never any option to negotiate anything. And whenever I have had an issue with certain cpt's being below Medicare rate - they say "call the provider rep at the carrier" then when I do - they just say" there is no negotiating. Very frustrating. Am I getting these cookie cutter answers from everyone involved because we are part of the IPA on the contracting? What if I want to do individual contracts for the physicians and drop the IPA company? Is that a better option to be able to renegotiate our current fees? I am in Texas - if anyone out there is also in Texas in a small group practice -can you recommend certain credentialing companies vs. the pro's and con's of individual contracts.

Thanks
 
Once you are part of an IPA, you live with the contracts they sign. Depending on the area you live in, this might be the best and easiest way but it depends.

I personally negotiated contracts with the major carriers in my area and got more than the IPA was asking.

There is risk though because once you drop the IPA, the insurance carrier is not required to contract with you if they feel they have enough coverage for your specialty in your area. Be careful.

From the insurance carrier perspective, they know the IPA is that fastest and easiest as it brings a group of doctors to them that can cover the various specialties in the area.

I would contact the major insurance carriers and see if they are open to negotiating an individual contract before you drop the IPA. By the way, what is the language in the IPA contract to not be par through them?

Good luck
 
You have to know what you are looking for and what your parameters are. I have done this but then I am a CPA and have negotiated many contracts. You will need to know the CPT codes that are vital to you and know what you are looking to obtain as a fee. Remember they have an IPA and unless you are something out of the ordinary - they will wonder why they should pay you more than the other doctors in the IPA. Know how many members, visits, levels, etc.

How many other providers in the IPA could service these patients? Is your practice potentially a key practice the the IPA.

There are many strategy questions you need to review before even thinking about negotiating.

Hopefully this little bit will hlep!!

Mike
 
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