Tips for a Compelling Letter for an Insurance Raise

Today’s post comes from my colleague who, like many private practice therapists, found herself struggling to accept insurance rates and still pay her bills.

Well, did you know therapists can request a raise from the insurance company? my colleague did, and she shared the letter template so that other therapists can request pay increases. With recent inflation, we deserve to pay our bills too!

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If you have been in an insurance network for over a year, you have the right to inquire about a raise in the rates for your contracted service. Given inflation, you can (and should!) hold them accountable for raising your rates to account for increases in overhead. While I cannot claim expert status in this area, I did extensive research before drafting my letter, and had success with my most recent raise request. 

Here are the major points to include:

  1. Highlight how long you have served their customers and your enjoyment in working with them. 
  2. Make note of any referral sources you have in your community (even if it’s a general statement such as local physicians, psychiatrists, or other health care providers). This demonstrates your active involvement in coordination of care and connection with other in-network providers.
  3. Identify changes in overhead costs or general inflation trends (if applicable). I referenced the average inflation rate within the past two years since I started in their network. I noted how this has increased my operating costs (if your experience is anything like mine, crucial things like rent, your records system, and other platforms are all likely more expensive).
  4. Emphasize how irreplaceable you are to their network. Identify relevant trainings/continuing education you have pursued. Note any niche areas you specialize in. Identify populations you work with (children, teens, families, or older adults are particularly in-demand). Share if you offer evening hours or weekend times to accommodate the schedules of working/in school clients. This is your opportunity to demonstrate why they should invest in keeping you in their network.
  5. Create a table that notes your present rates for the billing codes you used and a column for your requested rates. This makes it easy to read and clear about what you’re asking for. There isn’t a clear guideline regarding how much you should/shouldn’t ask for. In most cases, the insurance company will negotiate with you, so do not be afraid ask high. I factored in the inflation rate with some additional wiggle room to account for my time on their panel and my additional training. 
  6. Share your interest in continuing to serve their customers for a long time. While this isn’t a necessity, I consider this a courtesy that demonstrates good faith and offers a kind conclusion to your letter.

Below is a template I created:

Name of Insurance Network Coordinator
Address
Number 
Fax

Re: Rate Increase 

Date of Letter

Dear ____________,

I am kindly requesting your review and consideration for an adjustment in my contracted rates for service. 

I am a (your credentials/licensure) and have been serving clients through (insurance company) since (date). The demand for mental health services in the past two years have been unprecedented. The referrals I receive for my practice significantly out-pace the availability I have. I receive referrals regularly from various primary care and pediatric practices in the greater (your city) area. With that demand has also come an increase in overhead costs to match current inflation trends. Inflation has increased overhead costs by, on average, 8.26% over the past two years. I wish to continue to be able to make the important services I offer available to your customers, which is why I am requesting an adjustment in rates to match inflation and demand for services.

Here are my current rates and my requested rates: 

CPT CodeCurrent RatesRequested Rates
90791$$
90837$$
90834$$
90832$$
Fill in the table with your rate information

I am one of the only providers in my area to offer several unique specialized psychotherapy services that have required additional training. These include:

  • Bullet points of niche services your offer

I also work with these specialized populations:

  • List populations you work with

I also offer evening appointment hours to meet the academic and work needs of my clients.

In conclusion, I appreciate your consideration of my request for adjustment in rates to reflect the high demand for my services in addition to the level of specialized services I offer. I have greatly enjoyed working with (insurance company) customers and wish to continue serving them for many years. 

Sincerely,

Your name and contact information

Published by Dr Marschall

Dr. Amy Marschall received her Psy.D. from the University of Hartford in September 2015. Her clinical interests are varied and include child and adolescent therapy, TF-CBT, rural psychology, telemental health, sexual and domestic violence, psychological assessment, and mental illness prevention. Dr. Marschall presently works in the Child and Adolescent Therapy Clinic at Sioux Falls Psychological Services in Sioux Falls, South Dakota, where she provides individual and family therapy and psychological assessment to children, adolescents, and college students. She also facilitates an art therapy group for adolescents and college students with anxiety and depression. Dr. Amy Marschall is certified in Trauma-Focused Cognitive Behavioral Therapy and Telemental Health.

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