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NJ healthcare insurance negotiation deal: 3 lessons

New Jersey healthcare company Humana Inc. recently adjusted its insurance offerings to expand in-network access for members. After much negotiations with local healthcare providers, the private insurance provider agreed to expand its terms to include additional physician practices.

How did these other physician practices expand Humana’s coverage and what can other practices in the area learn from their methods?

The negotiations provide a number of valuable lessons for healthcare providers throughout the area. Three examples that apply to most practices throughout the area include:

  • Negotiations are possible. Whether a large private practice or a small group, physician practices can negotiate with insurance providers to expand their in-network options to help better serve their patients. Those who are not in-network can enter into negotiations with insurance providers to expand coverage.
  • Contracts are important. Both parties used a contract to solidify the details of the expansion of coverage. These terms help to better ensure the insurance provider will abide by the agreed upon negotiations and gives the healthcare provider a means to fight back if the insurance provider attempts to back out of the agreement at a later date.
  • Prepare for transparency. Although the exact details of the agreement are not available, certain information for the insurance provider’s investors is available. This includes information about the filings with the Securities and Exchange Commission, annual reports and earnings news releases.

It is important to pursue such negotiations with a combination of aggression and discretion. If careful steps are not taken, information discussed during negotiations could become public knowledge. This could undermine the practice’s goals.