Wiki Price negotiations

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AppleValley, CA
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I find myself in a jam when trying to price negotiate, as we are an out of network facility and the main surgeon is out of network as well. If anyone could give me pointers on how to price negotiate it would be greatly appreciated.
 
Who are you negotiating with? Insurance companies? Do they need you or do you need them? Meaning, do they have in-network alternatives? And are these non-emergencies?

If they need you, then do something like their fee schedule or Medicare fee schedule, whichever is more, plus XX %.
If you need them, do the same at minus 5% (or whatever).

If it's an emergency, then they have to process the claim as if it were in network (in our state, California).
 
I am negotiating with MARS we are an ASC and they are contracting with the insurance companies I believe. As I stated before we are an out of network facility. They’re always pricing extremely low of the actual billed amount the previous biller would bill extremely high and get a decent amount.
 
Who are you negotiating with? Insurance companies? Do they need you or do you need them? Meaning, do they have in-network alternatives? And are these non-emergencies?

If they need you, then do something like their fee schedule or Medicare fee schedule, whichever is more, plus XX %.
If you need them, do the same at minus 5% (or whatever).

If it's an emergency, then they have to process the claim as if it were in network (in our state, California).
I am negotiating with MARS we are an ASC and they are contracting with the insurance companies I believe. As I stated before we are an out of network facility. They’re always pricing extremely low of the actual billed amount the previous biller would bill extremely high and get a decent amount.
 
It sounds like you are negotiating pricing of individual claims after the fact and not negotiating contracts with payers. If that's the case, you are in a position of strength because these are services that have already been performed and the money is owed, so you do not need to bend too much. The companies that do these out-of-network negotiations are getting a cut from any money they can save the insurance companies, so of course they will try to get you to come down as much as possible. In my experience, if you counter with a different amount, they will almost always accept it since getting some discount is better than none at all.

The question you should ask is what is the advantage that they are offering you in return for this discount? Usually, they're offering one or both of the following things: a prompt payment and/or payment at an in-network benefit level. Remember that since you're out of network, the insurance may pay less money to you, but the patient will still owe the full amount. So accepting these discounts can be beneficial to your patient too, which can certainly help you with patient satisfaction and ease of collection.

So you should ask yourself, or your manager and provider, would they rather have these things, or would they rather stick to their price and see how the insurance company is going to pay and then be tasked with the efforts of collecting any extra amounts from the patients. It will really depend on the services you are performing, your patient population, and the expectations you've set for your out-of-network patients as to what they understand they're going to owe. At the practice where I used to handle these, we decided that based on where our fees were set, a 20% discount off of our fees was worthwhile (because this was still better than what our in-network payers allowed, and was similar to the self-pay discounts we offered anyway). So this is what I always made as a counter-offer, and as best I recall, they almost always accepted this. I would certainly not accept the low offers they send to you in the first round. There's no reason you have to go along with that.
 
It sounds like you are negotiating pricing of individual claims after the fact and not negotiating contracts with payers. If that's the case, you are in a position of strength because these are services that have already been performed and the money is owed, so you do not need to bend too much. The companies that do these out-of-network negotiations are getting a cut from any money they can save the insurance companies, so of course they will try to get you to come down as much as possible. In my experience, if you counter with a different amount, they will almost always accept it since getting some discount is better than none at all.

The question you should ask is what is the advantage that they are offering you in return for this discount? Usually, they're offering one or both of the following things: a prompt payment and/or payment at an in-network benefit level. Remember that since you're out of network, the insurance may pay less money to you, but the patient will still owe the full amount. So accepting these discounts can be beneficial to your patient too, which can certainly help you with patient satisfaction and ease of collection.

So you should ask yourself, or your manager and provider, would they rather have these things, or would they rather stick to their price and see how the insurance company is going to pay and then be tasked with the efforts of collecting any extra amounts from the patients. It will really depend on the services you are performing, your patient population, and the expectations you've set for your out-of-network patients as to what they understand they're going to owe. At the practice where I used to handle these, we decided that based on where our fees were set, a 20% discount off of our fees was worthwhile (because this was still better than what our in-network payers allowed, and was similar to the self-pay discounts we offered anyway). So this is what I always made as a counter-offer, and as best I recall, they almost always accepted this. I would certainly not accept the low offers they send to you in the first round. There's no reason you have to go along with that.
Thank you I appreciate your advice.
 
MARS is horrible at negotiating with OON providers. I do not accept less than 80% of Fairhealth prices. You can also go by a percent of total charges. Again, we do not sign for less than 70% of total charges. Our charges are based off FairHealth. Hope this helps.
 
MARS is horrible at negotiating with OON providers. I do not accept less than 80% of Fairhealth prices. You can also go by a percent of total charges. Again, we do not sign for less than 70% of total charges. Our charges are based off FairHealth. Hope this helps.
I cannot agree more. I'm sitting here scratching my head in total amazement at how low they are pricing these claims. Especially for facility fee's. Cash patients pay more than their offering. But what's is this FairHealth charge you speak of. ?
 
MARS is horrible at negotiating with OON providers. I do not accept less than 80% of Fairhealth prices. You can also go by a percent of total charges. Again, we do not sign for less than 70% of total charges. Our charges are based off FairHealth. Hope this helps.
I recently started having a very hard time with MARS/Multiplan. They used to pay $350.00 for an office visit and now they are only allowing $197 - $245. When I told them that as per the Fair Health we should be getting $383.00 they told me that because they are a third party they cannot allow that amount. I am not accepting half of there proposals and so called max amounts.
 
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