How to Negotiate a Raise with Mental Health Insurance Panels

Getting a Raise

This private practice business guide will teach mental health practioners how to negotiate a raise and increase their income with behavioral health insurance panels. If you are not on insurance panels, learn how to apply and get accepted here.

Like with any job, employees who over-preform for their company deserve higher wages. While reading this guide, keep the following frame of reference in mind: the insurance panel is your employeer and you are exceeding expectations. From this mindset, negotiating a raise is common sense.6593226_s

Preparation

Like with your original insurance panel application, we’re going to take some time preparing your differentiating and high-impact service offerings to explain to insurance panels why you are an asset (that needs to be nurtured) to their company.

1) Create a list of differentiating factors, including: cultural diversity, multiple languages spoken, emergency or crisis treatment, seeing a large quantity of their clients, serving under-represented locations, early morning, late evening, and weekend hours, do you do home visits, specialize with kids, chemical dependency or dual diagnosis, autism, or veterans. Add specializations requiring education and certificates. Use the buzz-words that patients and panels are looking for. Sell yourself a little here.

2) Have you continued your education and learned new modalities of practice? Add these under a new section “Continued Education”. Panels want to see you are expanding your service offerings through time.

3) Write down your current contracted rate for common CPT codes for that panel. Look up the regulars: 90791, 90834, 90837, 90791, 90847 and write down the rates you are paid (the insurace payment + the patient responsibility).  [See our guide to CPT codes here].

4) Multiply your contracted rate for each CPT code by “1.05”. This means you are negotiating for a 5% raise which will feel substantial in your bank account but isn’t outrageous by most standards. (Don’t worry, you can negotiate on a semi-regular basis).

Finally, we’re going to draft a letter summarizing all the aforementioned information. Most panels will require you to submit a written appeal so let’s get this out of the way now as it can be used as a template for other panels and in the future.

Drafting a Compensation Letter

Here is an sensible format for your letter.

  • State your intention of the letter: to apply for increased compensation based on merit and expertise.
  • State how long you’ve been contracted with that panel. Include the number of patients you see on a regular basis from that panel as well (the higher, the better).
  • Explain your specialization, credentials, skills, and differentiating factors.
  • Discuss your continued education and new services provided.
  • Create a simple table listing the CPT codes you most commonly bill for and your suggested new rates.
  • State your enjoyment of working with this panel and that you hope to continue working with them for another X years.

Reaching Out and Applying

Time to take the scariest step of all: contact your panel and apply!

Call up the Provider Relations Department for your panel and ask about where and how to apply for a raise — each panel is different.  Usually you’ll get information about faxing or mailing your request and if not, ask for it.  Ask for full name or names of representatives who serve these requests, as a letter written to someone specifically is better than a letter written to “Admin”.

Simultaneous, you may get forwarded to the correct representative immediately.  Be prepared!

Interview Tips

If you are forwarded to a rep or are requested to follow up with an interview, avoid some of these common mistakes:

  • Complaining!  Don’t complain about working for your employer, especially if you are applying for a raise.  This seems like common sense but make sure your frame of mind is representing your enhanced skillset and continued education as a growing asset to the company.
  • Don’t threaten to quit under any circumstances, rather suggest that you strongly feel your services ought to be rewarded appropriately.
  • Over-representing your level of expertise or “sell” too hard.  Simply be accurate and proud of the services you provide which displays confidence in an appropriate manner.

Make sure to do the following:

  • Be personable and friendly.  Ask the representative their name and use it in conversation.
  • Explain the time and money you spend on your continued education and enhanced service offerings.
  • Make it clear you enjoy working with that panel and hope to continue an “even stronger relationship” in the future.
  • Don’t worry about it!  If you’re nervous, call a friend or colleague first to get out of your head and have your voice warmed up.  It may sound ridiculous, but forcing yourself to smile can help as well.

FAQ

I admit it, I’m afraid!

Absolutely, you are!  If you weren’t, you might not have a pulse.  This is the #1 reason that mental health practitioners don’t negotiate their income so it’s understandable and, if you can actually get the courage to do it, is a huge competitive advantage.

Like anything scary, orient yourself around an environment that is comfortable and familiar, do some breathing exercises, call a friend, and then just go for it!  Unfortunately the process is extremely simple but can be extremely emotionally difficult.  Accept these factors and give it a shot regardless.  Judge your success on having tried, not being nervous.

I tried and got denied.

Three simple suggestions: 1) don’t take it personally, you’ll have plenty of opportunities in the future.  2) Contact your rep or admin and ask them what they are looking for and what are the reasons requests like these are approved.  Consider their answers seriously and see if you can work to increase your chances of getting a raise in the future by beginning to incorporate them today. 3)  Apply again in 6 months!

How long should I be on a panel before I negotiate a raise?

In an ideal world, income follows a meritocratic system of economics.  Unfortunately, in the real world, you may need to wait 2 years before you apply for a raise.  If you have no new skills or education to speak of, you might not even deserve a raise in the first place.  Keep this simple facts in mind when applying: you need to earn an increase in income to earn an increase in income.  Work on your skills and education and bolster your portfolio of services to offer before applying.  When you can clearly show you’re an appreciating asset to the insurance panel, your chances increase dramatically.

I only got a 3% raise!

Great job!!  3% is a lot more than 0%, so good on you for giving it a shot.  Keep up the good work, keep educating yourself and expanding your skillset, and apply again in 6 months!

10 Comments

  1. Yeshiva Davis December 5, 2016 at 7:56 am #

    Good morning:
    I’m having a difficult time coming up with a system to manage insurance billing (e.g. managing EOBs, deductible and copay changes, denials, EAPs, etc). Since I don’t have a solid system in place, I’m losing lots of money. I need someone to teach me how to create a system that is efficient and incorporates all the ‘surprises’ of working with insurance companies. Is this a service you provide? If not, do you know someone who does? I look forward to hearing back from you.
    Yeshiva – yeshiva@kandstherapy.com

    Reply

  2. Jacqui January 25, 2017 at 1:07 pm #

    Quick question about negotiating a raise. I work in a very expensive area and the reimbursement rate is only 1/3 of my standard rate. (and I’m on the low end of the scale for this area) Should I include that discrepancy in my letter or is that inappropriate?
    Thanks

    Reply

    • admin February 6, 2017 at 11:46 am #

      You can include it but their rates will be based on other provider rates in the area, not the ratio of your reimbursement to full fee, so expect this to not have much of an impact.

      Reply

  3. Danita February 6, 2017 at 11:40 am #

    Hello,
    I am in the process of negotiating a rate raise. Is it appropriate to mention the other insurance panels that pay more? Also, the panel in which I am requesting a raise was paying significantly more for the past two years and at the end of last year, I received a letter that the rate they were paying was an error. Consequently, my income decreased this year by $24 per client. Should any of this be included in my letter? Thank you for your help.

    Reply

    • admin February 6, 2017 at 11:45 am #

      It does make sense to include all relevant information in your appeal for a higher rate! Definitely include this information.

      Reply

    • Denny February 8, 2017 at 5:38 pm #

      It isn’t inappropriate to mention you are receiving more competitive rates if it’s true that it will reduce the number of patients you will see with that particular insurance company. Being truthful is the most important part.

      The reduction in your rate is a separate matter that you should address with that specific insurance company!

      Reply

      Denny
  4. Mark Michalica November 3, 2017 at 8:29 pm #

    You’re in the right business Denny. Unfortunately MH practitioners are, if reliant on insurance companies, in a tough place.
    I like your suggestions, but honestly the only ones worthwhile are BCBS, Aetna, Medicaid in some cases, Multiplan…you can skip Cigna, and UHC, and most EAP’s (some are more willing to negotiate)

    Reply

  5. Bonnie December 4, 2018 at 7:25 am #

    Hi
    I am want to ask for a raise with MHN. They pay only $50.00 for a 90834 which averages out to be $15.00 below the standard rate as compared to other HMOs panels that I am in. Should I mention that in my letter?

    Reply

    • Denny December 5, 2018 at 10:27 am #

      Definitely provide that sort of data, yes!

      Reply

      Denny

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