Inflation.  A pandemic.  Insane increases in demands for mental health providers.   What a 2020 and 2021.

As a therapist or mental health provider in private practice working with insurance, your contracted rates with insurance companies are in essence your fee caps for your hourly income.  With rising inflation, meaning increased costs of goods, our purchasing power per dollar has dropped.

The USA Consumer Price Index has now shown a 6.2% increase in prices in 2021.  This is inflation: the increase in prices associated with an increase in money supply.  (Source)  The inversion of this statistic is that if you haven’t had an increase in your rates in 2021, you’ve lost 6% of your hourly rate.

Let’s figure out how to get that money back and then some.  In this guide, we’ll walk you through the process of asking for a raise with insurance companies.

Increase Your Mental Health Reimbursement Rate [Video]

Reimbursement Rate Increase Guide for Mental Health Providers [PDF]

Increase Your Reimbursement Rates For Mental Health Services

Gather Insurance Provider Relations Information

Step one is to find contact information for the various insurance companies that you’re working with.  Here’s a very short list that can get you started:  https://therathink.com/provider-address-change-forms/

You will need to find the provider relations mailing address for your respective insurance company and the best way to find that is to call provider relations directly.

Gather up this information for each of the insurance contracts you’re working with!

Use Our Template Tool!

Try out our rate negotiation template tool here: https://therathink.com/rate-negotiation-tool/

Draft Your Letter

PLEASE copy this template and adjust it to your needs.  If this template helped you out, please share it with colleagues or on social media so it can help more providers.  Mental health providers deserve higher wages and we hope this template helps.

Note:  If you have not requested an increase in your rates in the last two years, consider a high ask of 10%-15%.  If you have received an increase in rates, ask for something more modest like 6.5%-10%.

Dear Provider Relations Specialist,

I’m writing on behalf of myself, ___________________, NPI (12345678910), and my practice, _________________, Group NPI  (10987654321).   This letter is a request for an increase in reimbursement rates for the routine outpatient mental health services that I provide and have provided to (Aetna, Cigna, UHC) clients for _____ years.

Due to the nature of the world in 2020 and 2021 leading into 2022, mental health providers like myself require an increase in wages.  Inflation is here.  The Consumer Price Index stated by the federal government has increased 6.2% in 2021 alone (https://www.bls.gov/opub/ted/2021/consumer-prices-increase-6-2-percent-for-the-year-ended-october-2021.htm).  I’m feeling these price increases at the grocery store, gas station, and on our monthly bills.  To afford these changes in routine spending, I’m requesting this increase in reimbursement.

(OPTIONAL, examples)  Beyond these financial concerns, I have continued to seek education regarding treatment and care for my clients (patients).  I have completed the following continued education courses:

• Course 1
• Program 2
• Conference 3
• etc

(OPTIONAL, examples)  I also specialize in the following languages and treatment modalities and offer additional hours during the following times:

• English, Spanish
• Dialectical Behavioral Therapy (DBT)
• EMDR
• Saturday Availability (11am to 3pm)
• After-work Availability (7pm-9pm)
• Holiday availability on Thanksgiving, Christmas

*NOTE* Do not lie here!  Obvious but please be honest.

Finally, due to the dramatic increase in demand for mental health services and the added stresses involved in treatment due to these unusual times, I request an increase in pay as an essential and integral worker serving ______(Aetna, Cigna, etc) clients.

For the aforementioned reasons, I am requesting reimbursement increases for the following CPT codes.

CPT Code Requests:

90834:  +12%, New Rate: $102

90837: +10%, New Rate: $91

90791: +8%, New Rate:  $122

90847:  +10%, New Rate: $112

90846:  +10%, New Rate: $105

I have enjoyed serving (Aetna, Cigna, etc) clients and hope to do so in the future.  In order to ensure I do not change the proportion of clients away from (Aetna, Cigna, etc), I ask for a fair but competitive increase in pricing to keep up with my other insurance contracts.

Thank you for spending your time and energy in consideration to this pay increase request.  I hope to continue to serve (Aetna, Cigna) clients for years to come.

Thank you again,

Provider / Practice Name

Practice Address

Practice Billing NPI

Submit, Confirm, and Wait!

Make sure to send your letter with an authorized signature required.  This is a good use of money!   You will get a tracking number associated with the letter you send that can prove the letter was received.

After waiting three to four weeks for receipt and processing, call provider relations to ensure your request has been received.

Now for the worst part: waiting.

Conclusion

Please comment below and let us know if you have been awarded increases in pay!  And we hope this short guide and template can help make a meaningful impact on you and your family’s financial wellbeing in 2022 and for years to come.

Cheers!

-Denny & the TheraThink Team