How to Get a Raise (in Your Reimbursement Rate)

In my work consulting with therapists around insurance issues, complaints about reimbursement rates describes the majority of practitioners’ pain points.

Yet, most practitioners I’ve spoken with have never asked insurance payers for a raise. They simply presume this request would end be denied.

Therefore, it might surprise you to learn that practitioners are often able to successfully negotiate raises in reimbursement rates from insurance networks.

Here’s how to give it a shot.

Steps to request a raise from insurance networks

I’ve been able to negotiate raises for some of my contracts, and I’ve also been thrilled to help many therapists request and receive raises for themselves.

One of the most important things I have found is that there seems to be no way to predict which practitioners will receive raises.

So, why not try it? You have nothing to lose.

1. Call the insurance plan’s provider relations or provider contracting department

Find out where to send a letter requesting a reimbursement rate increase. Ask them whether you can fax or e-mail it, and/or to whom it should be addressed.

Be prepared to discuss your request and to defend why you feel you deserve a raise in case they follow up with questions.

Sometimes reimbursement rate raise request interview questions are discussed via phone, though more often you will be asked to put your request in writing.

2. What to include in your letter to the insurance network

In your letter to the insurance network, be sure to mention how long you have been with the network.

Also mention how many years of experience you’ve had as a managed care provider.

If you are a high-volume provider and you already serve a large number of their members, mention that number if it’s significant.

3. Describe your most impressive specialties, skills, and experience

What makes you stand apart from your colleagues?

Include in-demand experience and specialties even if they are 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

4. Mention your training, experience, or certification

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.

5. Consider your unique selling proposition

How you are able to provide access and availability to mental health services that many other therapists don’t?

For example, do you offer weekend hours, evening hours?  Do you work in an underserved area, rural area, or “therapy desert’?  

Do you have two offices so you can serve more plan members over a wider geographical area?

6. What additional services can or do 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.

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.

Some final tips on getting a raise in your reimbursement rate

Be prepared to name the updated and increased reimbursement fees you are requesting for each service you provide (use CPT codes).  

I typically suggest you ask for $20 more than you are getting now for each type of service.

Don’t complain 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 to the insurance network. You may, however, hint that you are unsure if you can continue at the current rate.

For assistance crafting your customized raise request, contact me at barbgris@aol.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’re unsuccessful, try again in six months. You may consider asking if there is anything you might do to earn a fee increase.

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