Health Plan Contracting and Negotiation

Our attorneys assist practitioners, independent practice associations, and multispecialty groups with contracting with health plans and negotiating reimbursement rates. Health plan contracts are unique. They contain terms and conditions not found in other agreements, many of which stem from the evolving web of federal and state regulations governing managed care, continuity of care for health plan members, and reimbursement.

Our attorneys have over a decade of experience reviewing and negotiating health plan contracts. Although each client has unique needs, our attorneys understand the issues that typically rise to the forefront during negotiations of these types of agreements.

Reimbursement rates typically take center stage in health plan contracting. As the cost of doing business continues to increase, it is critically important to prepare and implement a long-term strategy for negotiating reimbursement. All too often, our attorneys speak with potential clients who have not requested an increase in reimbursement for years. In these situations, it is generally very difficult to bring reimbursement up to current market rates in a single round of negotiation. The process takes time and can be frustrating for providers and practices.

Although every situation is different, in our attorneys’ experience, the most effective approach is to implement a strategy in which the provider and/or practice consistently engages the health plan and maintains an ongoing dialogue regarding reimbursement. Our attorneys have over a decade of experience reviewing health plan contracts, engaging in discussions and negotiations with health plans, and developing targeted strategies designed to increase reimbursement rates.

If you or your practice need assistance reviewing or negotiating health plan contracts, our attorneys stand ready to assist.