You CAN Negotiate a Health Plan Contract

Many physicians assume that attempting to negotiate a health plan contract is hopeless — but that is a myth. New survey data from TMA shows that practices’ negotiation attempts are successful more often than not. Members report 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.

Now is a good time to assess contracts — before annual employer open enrollment deadlines, many of which are in the fall. TMA can help:

Revised Sept. 17, 2015 

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