It will come as no surprise that in my work consulting with therapists around insurance issues, reimbursement rates are by far the biggest source of provider complaints.
Yet most providers I’ve spoken with have never asked for a raise, assuming they would be unsuccessful. So you might be surprised to learn that providers are often able to negotiate raises. Recently, I was able to negotiate two raises for my contracts, and I have been happy to help many therapists get raises for themselves. One of the most important things I have found is that there seems to be no way to predict who will get raises. So why not try it? You’ve got nothing to lose.
Steps for requesting a raise:
- Call the insurance plan’s Provider Relations or Provider Contracting Department. Find out where to send the letter requesting a reimbursement rate increase, whether you can fax or e-mail it, and to whom you should address it. Be prepared to discuss your request and to defend why you feel you deserve a raise in case they ask. Some raise request interviews are discussed via phone, though more often you will likely be asked to put your request in writing.
- In your letter, include how long you have been with the network, and your years of experience as a managed care provider. If you are a high-volume provider or already serve a large number of their members, mention how many, if the number is large.
- Describe your most impressive specialties, skills, and experience, even if it is old experience. What makes you stand apart from your colleagues? Include great experience even if it is in an area in which you don’t want to receive referrals. Experience and specialities health plans may be willing to pay more for may include working with:
- children and adolescents
- ADHD and Autism, especially using ABA techniques
- PTSD / trauma, especially using EMDR
- substance abuse or other addictions/compulsive behaviors
- eating disorders
- veteran’s issues / military families
- chronic pain
- severe mental illnesses / personality disorders
- ability to speak languages other than English, including sign-language
- crisis/emergency care
- Willingness to treat psychiatric inpatients after their discharge
- Ask yourself, “what additional education or training or experience do I now have that I didn’t have when I applied to the plan, that might make me worth more?” You may be able to negotiate a higher rate if you have received special advanced trainings or certifications, such as Certified Employee Assistance Professional (CEAP) or Substance Abuse Professional (SAP), or EMDR Certification. It is also a good idea to highlight advanced training in the areas of Cognitive Behavioral Therapy or Brief Therapy.
- Think about how you are able to provide access and availability that many other therapists don’t. Do you offer weekend hours, evening hours? Do you work in an underserved area? Do you have two offices so you can serve more plan members over a wider geographical area?
- What else can you offer beyond therapy? Can you provide employer training or wellness lectures or Critical Incident Stress debriefings? Employee Assistance Plans (EAP) especially may be willing to pay more for this experience or training.
- Finally, you may have an advantage if an employer specifically requests your inclusion, or if you are part of a multidisciplinary and/or group practice that can offer a continuum of services.
Bottom line: Let them know why you are worth paying a bit more to keep.
A few final tips:
- Name the fees you are requesting for each service you provide (use CPT codes). I usually suggest you ask for $20 more than you are getting now for each type of service.
- Don’t whine about how your office expenses have gone up, the cost of your daughter’s college or your son’s braces. If you want to quickly mention that you are seeking a rate increase in part due to the higher cost of living, fine, but don’t dwell on it — it’s better to focus on your value to the network.
- Avoid making resignation threats or blackmailing them. You may, however, hint you are unsure if you can continue at the current rate.
- For assistance crafting your customized raise request, contact me at email@example.com to schedule a consultation. As part of our consultation I will provide a sample raise request letter you can use as a template.
If you are unsuccessful, try again in six months. You may consider asking if there is anything you might do to earn a fee increase.