Requesting a Fee Increase with Insurance Companies

Requesting a Fee Increase with Insurance Companies as a Group Practice

I want you to make money. I want you and your clinicians to be paid fairly. If you are a part of any practice building Facebook group, you are well aware of the concerns that clinicians have over insurance reimbursement rates. I get it. I’m concerned about reimbursement rates too! For that reason, I make it a part of my job as a group practice owner to request fee schedule increases. I’d like to share my process and give suggestions to helping you increase your clinicians’ income and your bottom line.

My group practice is in network with a handful of insurances. I make it a priority to communicate with insurances about fee increases each year (from the time of last request or increase). Last year, I was able to get an increase with all but one insurance (which I unpaneled with) and all but one EAP (which I unpaneled with as well). Most of these increases were upward of $15 per CPT code. Not too shabby. Just think, even small increases every year or two will add up. And if an insurance company denies an increase, it’s the perfect time to review your cost/benefit analysis to being paneled with that insurance (a blog post for another day).

So, here’s what I have found to work:

  1. Write a formal document to your network representative (for insurances, for EAPs its surprisingly easy; just a phone call or email to your rep). Email or fax it to them.
    2. On this document, list out your group practice specialties, especially ones that are desirable or needed in your community. Discuss your impact on your community, what do you offer that other practices in the area don’t? Does someone speak a second language, do EMDR, treat a specific population in need, or have a special certification? Are you a multidisciplinary practice-insurance companies tend to love a practice that meets various needs.
    3. Write your full fee rate for each CPT code you use.
    4. List your current rates per CPT code with THAT insurance.
    5. List any rates you have with other insurances (minus their names) that are above the insurance you are requesting from.
    6. Last, list the increased rates you are requesting from that insurance by CPT code.
    7. Give them the percentage of that insurance your practice sees or actual current number, whichever has the biggest impact.
    8. End with a way for them to contact you with a deadline for responding.

It’s on us as practitioners who take insurance to be assertive and request fair reimbursement rates. Not only does that help your clinicians get a raise, it also increases your business revenue. Even more, we deserve fair compensation. So, if you feel financially slighted by an insurance company, get Word out and start typing!  Download my fee increase request form below. Good luck!

To hear more about fee schedule increases, listen to my podcast episode about it below!

Requesting a Fee Increase with Insurance Companies

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MAUREEN WERRBACH
Maureen Werrbach is a psychotherapist, group practice owner and group practice coach. Learn more about her coaching services here:
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2018-10-02T15:53:46+00:00 By |2 Comments

2 Comments

  1. Vicky Reichert August 22, 2017 at 6:05 pm - Reply

    This is great advice. I’ve been wanting to pursue this for a while, and now that my group is growing, I’m hoping I have more leverage. My concern is that I will send the email, and like most things with insurance companies, it goes into a black hole and I never hear back. How do I find a human being who will follow up?

    • The Group Practice Exchange August 28, 2017 at 5:32 pm - Reply

      Hey! It took me a while to find my network representatives, but that’s the place to start. When you call, they will usually send you to a voicemail of the person who handles fee schedule increases. That person will tell you where to mail or fax that info. For all things that insurance companies are notorious for losing information, oddly enough my rate increases have never gotten “lost.” Good luck!

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