9 ways to bring real leverage to your 2027 payer talks

Ask physicians how much bargaining power they have with private insurers and most will tell you not much. In the Medscape Private-Payer and Government Insurance Report 2026, published Oct. 2 and based on a survey of 751 physicians, only 5 percent said they have significant leverage when negotiating private-payer contracts. More than 40 percent said they have none at all.

The rest of the report shows why that matters. About half of respondents said private-payer rates have fallen over the past five years, and 38 percent said rates have held flat while staff, rent and supply costs kept climbing. Doral Jacobsen, CEO of Prosper Beyond, has spent years sitting across from payers on behalf of practices, and she said the feeling of defeat usually starts with a bad prior negotiation and no plan for the next one. "When a practice understands its worth, they find their power," she told Physicians Practice.

With 2027 renewals approaching, the gap between the 5 percent and everyone else comes down mostly to preparation. Jacobsen's playbook, drawn from two interviews with Physicians Practice, starts long before the first meeting. Here are nine places to start.