These are challenging times for neurologists in private practice. To keep their doors open, many are having to make difficult financial decisions, including whether to stay with insurance carriers. Dropping a carrier can be painful. It is not an uncomplicated process, and frankly, it hurts to tell your patients that you can’t take their insurance anymore.
Brad Klein, MD, MBA

“It’s not that you just want to make more money,” says Brad Klein, MD, MBA, a neurologist practicing in Pennsylvania. “The goal is to take care of the community, but if a particular insurance payer wants to pay you so low that it impacts your ability to survive, then you’ve got to do something to keep those doors open for the community.”

Some neurologists have opted to drop insurance all together and start private-pay or concierge practices. But that is a huge decision. Before you head down that road or even consider dropping that one carrier, consider negotiating for better rates. According to Klein, not many neurologists realize it is possible to negotiate your way to higher reimbursements with individual insurance carriers. Sometimes all you have to do is ask.

Sometimes, though, you will have to do more than just ask; you will have to show them (and often in writing) why it is to their advantage keep you on by paying you more. To do this, of course, you have to know these things yourself, and that will take some research.

There is no one formula that will work for everyone, Klein cautions, but there are factors that put you and your practice at a distinct advantage. The more robust these are, the more negotiating power you’ll have with an insurance company. Here are the factors that Klein offers as most important.

Good quality outcomes

You know when you are doing a good job, and it’s great when your patients say “thank you” and appreciate how much you’ve helped them. But to get paid for those same services, increasingly you have to prove their quality. That is a big part of Medicare’s current model, and other insurance carriers are sure to follow. Make sure you have a good quality reporting tool in place to capture the good work you do. Your current EMR may already have this component built in, or you can check out the Axon Registry, free to AAN members.

Geographic isolation

Are you the only neurologist in your geographic area? If an insurance carrier doesn’t have anyone else, or has only a few others they can send their subscribers to, they will work harder to keep you happy. The same is true if you are the only neurologist that offers a special service or expertise in your area. Find out what other neurologists in your area are offering. Use this information to prove that you are providing a critical service to their insured.

The particular insurance carrier is not the majority of your income

You need to understand your payer mix. That means knowing how much of your income is dependent on each carrier you participate with. Heavy reliance on a single payer for your income (more than 40%) may make it impractical to consider actually leaving. Go into such negotiations knowing you may need to bend more quickly to the demands of the insurer.

Long wait list

A longer wait list is an indicator that you are filling a need that is not easily met, and that will make you more valuable to the carrier. Find out the average wait time for other neurology practices in your area so you can offer a comparison. Three months is a lot different than two weeks to these companies, so know where you stand. Klein cautions that you must make sure everyone’s wait list is considered. A change that is fine for one doctor may be disastrous for another in the same practice.

Well established and solvent patient following

Klein says it is surprising what an accurate picture you can get by simply asking your patients what they would do if you stopped taking their insurance. If you have a large and loyal following of patients, many will find a way to stay. Some plans will even allow them to still get reimbursed. Also, depending on the socioeconomic status of your community, your patients may have no problem paying your fees. It’s not always as gloomy as it looks at first, and this knowledge will better prepare you for negotiations.

A change in how (and how much) neurologists are being reimbursed for their services has been in the works for a while. Now, says Klein, “The time for waiting and seeing what happens is over. You have to be involved in the process.” It’s not enough just to be the best clinician you can be. You need to take a hard look at your books and make the most of all sources of income. That includes re-evaluating, and possibly renegotiating, your worth with insurance carriers.