Most private practice owners assume insurance companies won't negotiate. But what if you could increase your reimbursement rates with the right strategy, the right argument, and the right person?
In this episode of the Private Practice Owners Club, Nathan Shields sits down with David O'Hara of Brace Health to break down how private practice owners can negotiate better payer rates and stop leaving money on the table.
David shares what they've learned from hundreds of payer negotiations, including what payers actually care about, how to build leverage, how AI can identify opportunities, and why finding the right person inside an insurance company can make all the difference.
In this episode, you'll learn:
- Why some practices are successfully getting 5–10%+ rate increases
- How an additional $5 per visit can translate into significant annual revenue
- Why the highest-paying payers may actually be more willing to negotiate
- What insurance companies actually care about when negotiating rates
- Why network adequacy can give practices leverage
- How to use local market data to strengthen your negotiation
- How AI can identify geographic and specialty-specific opportunities
- Why simply telling payers that your costs have increased may not be enough
- Why you should focus your negotiation on specific rate increases
- How to determine what to ask for in a payer negotiation
- Why asking for a larger increase can sometimes be more effective
- How to find the right network or contracting manager
- Why some negotiations require persistent follow-up
- What happened after one practice sent 11 follow-up emails
- How building relationships with payer representatives can improve negotiations
- How successful negotiations can create immediate improvements to your bottom line
- Why negotiating reimbursement rates can also be a form of advocacy for the PT industry
- What practice owners should know before starting the negotiation process
Payer negotiations don't have to be complicated or adversarial. With the right strategy, preparation, and persistence, practice owners can create more leverage and potentially improve reimbursement.
If you're a private practice owner who wants to stop accepting low reimbursement rates and learn how to approach payer negotiations strategically, this episode is for you.
Want to talk about how we can help you with your PT business, or have a question you want to ask? Book a call with Nathan - https://calendly.com/ptoclub/discoverycall
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