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Thread: Negotiating with insurance

  1. #1
    Join Date
    Apr 2007

    Default Negotiating with insurance

    AAPC: Back to School
    Does anyone have any useful tools in negotiating reimbursement amounts for procedures, especially 99213, 99214, 99215, and injections with insurance companies? We are, of course, trying to get way more than they are offering.

  2. #2


    If you are one of the few specialities in your area, you have a lot of negotiating power. but even if you are not, I would due an analysis of your other contracts, if they are a lot lower than your other contracts, I would bring this up as a point. Also, even before you start negotiating you should clarify with your doctors one of two issues: Are you willing to walk away and term your contract? or Are you just trying to get better rates?. If you are willing to walk away, you may have a lot more negotiating power. One tactic you might take is to do analysis of your top 20 billed codes and ask for an increase in your top 20 codes, not all codes. If they are not willing to budge at all somtimes terming your contract is the better financial option depending how much of your practice is made up of this one insurance.

  3. #3
    Join Date
    Apr 2007
    Concord, NC or Rochester, NY


    This depends on your insurance carrier and region. If your practice has the ability to have power over the insurance carrier, there may be an option to negotiate. If you have no power, negotiations are in favor of the insurance carrier. I have gone down the road of terminating an insurance carrier but then we were a major player for the carrier and they quickly came back and negotiated in good faith.

    Therefore you have to have something that is unique to your practice that the insurance carrier needs in your area, otherwise you do not have any power with them.


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