Are You Being Underpaid? Understanding Your Insurance Reimbursement Rates

EPISODE SUMMARYYour reimbursement rate isn’t necessarily the market rate. In this episode of The Claim Game, Jeremy Zug explains why practice owners should look beyond their own contracts to understand what comparable practices are actually being paid.Jeremy explores how reimbursement benchmarking and market data can uncover hidden revenue opportunities, strengthen payer negotiations, and help practices make smarter decisions about their payer strategy. The bottom line: you can’t negotiate a rate you don’t know exists.KEYWORDSinsurance reimbursement rates, reimbursement benchmarking, payer negotiations, insurance contracts, fee schedules, behavioral health billing, mental health billing, private practice, payer strategy, reimbursement data, rate negotiation, revenue cycle management, practice managementTAKEAWAYSYour rate isn’t necessarily the market rate. Your contract shows what your practice is being paid, not what comparable practices are receiving. Small differences can have a major impact. A seemingly modest reimbursement gap can translate into significant lost revenue at scale.Market data creates leverage. Knowing what similar practices are paid can help you approach payer negotiations with better questions and stronger information. Small practices have advantages, too. Solo and small group practices may lack volume, but they often have more flexibility to adjust payer mix, services, and strategy. Reimbursement isn’t set in stone. Payers, services, markets, and rates can change—and practice owners can explore opportunities beyond their existing contracts. You can’t negotiate what you don’t know exists. Regularly benchmarking reimbursement can help you make more informed decisions about the future of your practice. CHAPTERS00:00 Your Reimbursement Rate Isn’t the Market Rate03:33 Using Market Data to Negotiate Smarter07:11 Getting Creative With Payers and Reimbursement10:22 See What Practices Like Yours Are Getting PaidRESOURCESToday Sponsors: Visit practicesol.com Check Out Rate Vantage Learn More About The Claim Game: Visit practicesol.com/podcastThe Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub. Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog. Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.