Episode 16: Tips For Preparing For Insurance Negotiations

The Private Medical Practice Academy

Episode 16: Tips For Preparing For Insurance Negotiations

December 30, 2020

Episode 16: Tips For Preparing For Insurance Negotiations

More likely than not, you are trying to get contracts with multiple insurance companies. And, in case you haven't figured it out yet–there are multiple steps in the contracting process. 

At this point you may have already made the initial contact to provider relations department requesting a contract. The health insurance company will send you a contract. You may be wondering…and then what?

 During this episode, I'll walk you through your next steps to making the contracting process easier.

Step 1: Be organized 

  • Print the contract and all communication
  • Put the contract in order
  • Use a color-coded binder to differentiate between insurance companies
  • Label everything, use dividers
  • Don't throw anything away–keep all documentation for future reference
  • Memorialize every conversation with the insurance company including names, dates and  summary of the verbal statements

Step 2: Assess your and the payer's positions

  • Avoid the temptation to think "I HAVE to be in network"
  • Evaluate the health insurance company's network. 

The goal here is to make sure that you are signing up to be in network with an insurance company that is actually to your benefit rather than just signing up to sign up. This is ultimately one of the keys to working smarter, not harder.

Step 3: Understand the Key Terms in a contract before you start to read it

  • Type of Agreement:
  • Amendment
  • Term, Termination, and Renewal
  • Claim Filing and Payment
  • Compensation

Step 4: Skim the Contract

Skim the agreement the first time through, locating the key data that you outlined in your checklist. Focus on what matters most, and don’t get lost in the verbiage. You’ll notice that the reimbursement is always an attachment at the very back of the agreement. Don't allow yourself to get bogged down by the recitals and definitions at the very beginning.

Step 5: Read the contract

  • Get an electronic copy of the contract and make red-lined changes as you go. Make sure that you turn on your track changes so that it's easier to identify changes. 
  • It's better to give your own proposed language rather than allow the other side to paraphrase your thoughts. 

Click here to get your checklist of the key contract terms.

If you would like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at

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