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It's negotiable: Fighting for a fair deal

Don't like the insurance plan contract you got in the mail? You've got more power to change it than you think.

By Robert Kazel, AMNews staff. Nov. 15, 2004.

Andy Tucker, MD, head of a seven-doctor pediatric group in Denver, talks about contract negotiations with health plans as a kind of tango -- a dance with a partner he doesn't especially like yet can't avoid, either. And he knows that choosing to be a wallflower -- the kind of physician who signs a deal thinking there's no way to contest it -- could cost his practice dearly.

In October, Dr. Tucker got in the mail a standard contract from a large commercial plan reminding him it was time to renew. In the cover letter, the plan announced it was dedicated to collaborating with doctors and improving relations with them, and that contracting would be simpler than ever. Just sign and date the document and be sure to use the return envelope, enclosed.

The sunny tone of the letter got Dr. Tucker angry, though, when he studied the numbers and found that the fee schedule had been cut considerably. "Whenever they send you a new contract, they seem to want to ding you a little more," he says. "Ninety percent of the time, it's a lower rate than you were getting before."

From experience, however, Dr. Tucker knew the lesson of the squeaky wheel. He telephoned his practice's representative at the health plan, fuming, and told her it was "ludicrous" to expect the medical group to accept the pay cut.

Without missing a beat, he says, the woman agreed to increase the schedule by 6%. Dr. Tucker told her that wasn't good enough. She said she could go up another 2%.

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