Are Raises Possible?

By Barbara Griswold, LMFT
(Updated February 13, 2017)

Reimbursement rates are by far the biggest source of provider complaints about working with insurance plans. 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 be able to help many therapists to get raises for themselves. I have also found 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 and ask where to send a letter requesting a reimbursement rate increase.  However, 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 you will likely be asked to put your request in writing.

• In your letter, include how long you have been with the network, 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, and your unique specialties or skills or experience, even if it is old experience. This may include:
  • children and adolescents
  • ADHD and Autism, especially using ABA techniques
  • PTSD / trauma, especially using EMDR
  • substance abuse or other addictions
  • eating disorders
  • veteran’s issues/military families
  • chronic pain
  • ability to speak languages other than English, including sign-language
  • crisis/emergency care
  • ability to provide post-discharge care for psychiatric inpatients
  • severe mental illnesses / personality disorders
• Ask yourself, “what additional education or training or experience do I now have that I didn’t when I applied to the plan, that might make me worth more?”  You may be able to negotiate a higher rate if you have special advanced trainings or certifications, such as Certified Employee Assistance Professional (CEAP) or Substance Abuse Professional (SAP), or EMDR.  They also love to see advanced training in Cognitive Behavioral Therapy or Brief Therapy.
• Think about how you are able to provide access and availability that many others 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 of the plan members over a wider geographical area?
• What else can you offer beyond therapy?  Can you provide employer training or lectures or Critical Incident Stress debriefings?
• 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.
• Find out where to send the letter, whether you can fax or e-mail it, and to whom you should address it.
• For assistance crafting your raise request, schedule a consultation at www.calendly.com/barbgris.  As part of our consultation, I can 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.

Q: Why can’t my professional organization lobby on my behalf for better rates?

A: Many providers wish their professional organizations would lobby managed care plans for raises on their behalf. However, most professional organizations will tell you that legally they are not allowed to become involved. But according to my research and the lawyers I have consulted, self-employed therapists have individual contracts with the plans, and cannot collectively bargain – with or without their professional associations. Only individuals who are employees who hold non-managerial positions can organize as a union does to collectively negotiate. As independent contractors, therapists cannot boycott, strike, threaten as a group to resign if rates are not increased, or fight together for a minimum reimbursement. This behavior would be considered “price fixing” or “restraint of trade,” and violates the Sherman Antitrust Act.

To land you in hot water, the plan would need only to establish that there has been some sort of “contract, combination, or conspiracy” between providers in an effort to collectively bargain and control rates. Such an agreement does not need to be in writing: According to many lawyers I’ve consulted and what I have read from trusted  online sources, even an informal discussion between therapists at a social function or via social media expressing dissatisfaction about a plan’s reimbursement rates, followed by a mass action such as resignation from that plan to protest rates could support a successful antitrust prosecution. This could result in fines up to $350,000 or three years’ imprisonment, or both.

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Barbara Griswold, LMFT, is the author of Navigating the Insurance Maze: The Therapist’s Complete Guide to Working with Insurance – And Whether You Should. To purchase the book or other resources for therapists, click here. Contact Barbara at barbgris@aol.com to get answers to your insurance questions.

Copyright 2017-, Barbara Griswold, LMFT. No part may be reproduced without written permission of the author.