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Are You Paid Enough? Check Your Insurance Rates
Enter what each insurer pays you per visit for your main codes, and see where you fall against the published in-network rates for providers like you in your state. It takes about 2 minutes. No patient data: only your fee schedule amounts.
How It Works
Insurers must publish the rates they pay in-network providers. We read those files and summarize them by payer, state, provider type and code. Your rate is placed in one of four bands: below the range, lower half, upper half or above the range. Where you are below the median, we show the gap per visit and what it adds up to over a year at your volume.
Most practices sign the first fee schedule a payer offers. If your rates are low, the guide to negotiating higher reimbursement rates explains when you have leverage and what to ask for.
Frequently Asked Questions
Where do the market numbers come from?
From the in-network rate files each insurer must publish under the federal Transparency in Coverage rule. We group the published rates by payer, state, provider type and procedure code, and show the 25th percentile, the median and the 75th percentile across the providers listed. Your actual contract may differ.
Do I need to share patient information?
No. Enter only the payer, the procedure code, the amount the payer allows you per visit (from your fee schedule or contract) and how many of those visits you have in a typical week. Never enter patient names, claims or remittance files.
What does the market range mean?
It is the middle half of published in-network rates: half of the listed providers of your type in your state are paid between the two numbers. Below the range means you are paid less than about three quarters of them for that code.
How is the yearly estimate calculated?
The gap between your rate and the median, times your visits per week, times 48 weeks. It is an estimate of what you would gain if the payer raised that code to the median, not a promise.
What if there is no data for my payer or code?
The results say so. We have files for Aetna, Cigna, UnitedHealthcare and Optum, Horizon BCBSNJ and Blue Cross Blue Shield of Texas, in the states and provider types we have processed so far. Our team can pull the numbers for a payer we do not show yet.
What does rate negotiation cost?
Rate negotiation is $500 per contract, success only: we only charge if the payer agrees to a better rate in writing. One contract is one payer agreement. Better means a net improvement across your main codes, weighted by your volume, with the focus codes and target agreed with you before we start.