How to Negotiate with Insurance Companies

Physical therapists (PTs), as clinicians, often have no experience or training in negotiating techniques and strategies. Almost no physical therapy literature addresses this issue and little literature from other health care professions deals with the negotiating process. Other factors contributing to weak negotiating skills among physical therapists and other medical practitioners include lack of time and discomfort with the very idea of negotiating. This article will discuss step by step the process of negotiating, provide you with some of the rules and tactics, and contribute to a discussion about improving negotiating skills.

How is negotiating with insurance companies different from negotiating with other companies?
Books about negotiating techniques often address having or creating leverage. In reality, there is very little leverage for physical therapists in negotiating with multi-million dollar insurance companies. That is something we have to accept. Thus, negotiations are different, difficult, and challenging-but not impossible. That is why these negotiations are unique.

One of the few situations in which physical therapists have some leverage is in rural areas where insurers encounter difficulties in obtaining practitioner coverage. Leverage also may exist when a practice provides a special service that the insurance company needs for its beneficiaries but is not provided in that geographical area.

We are not powerless, but we must become more creative and use allies to help us with leverage. The public, our patients, insurance commissioners, patient organizations, support groups, and the medical community can be powerful partners in negotiations. Think alliances and think positive.

How do I start negotiations when I have a problem with an insurance company?
Fostering relationships with insurance company personnel should be done before there is a problem. Cultivating and developing relationships and contacts will make it easier to address problems when they arise. You will know the people with whom you have to deal and those who are more knowledgeable about certain issues. So it is crucial for chapters and individual physical therapists to seek relationships and communication with insurance companies long before an issue becomes a problem and negotiations start.

The second step is prepare, prepare, prepare. Knowledge is power. Preparation always will pay off. Learn as much as you can about the organization, the company structure, the decision makers, the history of the issue, and any other pertinent information. Negotiating is a process, not an event. It goes through different stages. (1) Being prepared will help to move from one stage to the next without surprises. Negotiations with insurance companies-regardless of the topic discussed-are a long term process and should be approached that way. There are no quick fixes and resolutions but a grueling series of chess matches to get to a win-win solution. (2)

1. Chesanow N. The negotiating process: how to get what you want: do you want a less costly office lease, a higher salary, more vacation time? Try these tips. (Essential skills). Ophthalmology Times. 2005;30.19,Oct1:104.

2. Schultz I. 3 keys to negotiating a better managed-care contract: Know why your practice is valuable, research the panel you're joining, watch for pitfalls. Ophthalmology Times. 2000;25.9,May1:47.

Updated on: 12/09/09
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How Do I Prepare for Negotiations with Insurance Companies?

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