Abstract
Effective negotiation with health insurance payers is crucial for neurology practices
to maintain financial sustainability and optimal patient care. This paper outlines
strategic approaches to payer negotiations, emphasizing the importance of clearly
defining practice strengths, understanding market conditions, and leveraging detailed
contextual data to counter incomplete or misleading payer analytics. Specific considerations
discussed include customer service efficiency, claims management, provider–payer relationships,
clinical management policies, contract terms, and fee schedule clarity. We present
actionable negotiation strategies illustrated by a case study, highlighting tactics
such as targeted utilization reports, social media advocacy, and data-driven reimbursement
proposals. Additionally, practical advice is provided on managing payer interactions,
addressing common administrative inefficiencies, and strategically limiting patient
volumes when negotiations stall. This structured negotiation approach empowers neurologists
to effectively align clinical value with payer objectives, ensuring fair reimbursement
and enhanced practice viability.
Keywords
payer contract - managed care negotiations - utilization data
