MBS Home

Feature Article

Playing Hardball with the Managed Care Companies for Higher Allowances

You are a hospital based group who has made a reasonable case for being paid more than the current agreement stipulates.  You based your justification on how much other payers compensate in your area and what this payer allows in other markets.  It all makes sense.  But they aren’t listening and its time to get serious.  Before you send your contract termination letter, you best have a strategy or you could be a victim in this high stakes war. 

The first thing you must do is get the hospital on your side.  They don’t like managed care companies any more than you do.  But they like unhappy patients and cases being sent somewhere else even less.  Managed care companies know and will use this as leverage to convince the hospital you are just being greedy.   They will warn about the volume of complaining phone calls and the company’s need to send patients to another institution.  You need to get to the hospital first with the following messages:

Once you clear this hurdle, you need to have a strategy to address the collateral damage of this battle-the patients.  Keep in mind that Blue Shield and, soon to be implemented, United Healthcare will send any funds due your practice directly to the patient if you are not under contract causing you to chase the entire billed amount and not just the balance.  To address this and the prospective bad public relations you need do the following: