Fee Schedule Changes

November 1, 2007

One of our local insurance companies reduced our fee schedule and is paying at or below Medicare rates. In addition, it did not notify us in a timely manner that our fee schedule would change. Do we have any recourse besides terminating our contract?

Question: One of our local insurance companies reduced our fee schedule and is paying at or below Medicare rates. In addition, it did not notify us in a timely manner that our fee schedule would change. Do we have any recourse besides terminating our contract?

Answer: Our fee schedule surveys suggest that many commercial payers are reimbursing below Medicare. Consider what your full payment is, including copays and other patient portions, before determining that it is actually lower than Medicare, however. Allowables are dropping but other revenue is getting pushed to patients. You certainly can try to renegotiate the contract for a different fee schedule, especially if the terms are much lower than your other payers. If they don’t want to negotiate, why keep them?