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Insurance Negotiation
At The University of Kansas Health System, our priority is providing you with high-quality, compassionate care. Part of this commitment involves working with health insurance plans to ensure we earn fair rates for services and provide affordable care to you.
How insurance negotiation works
Insurance companies and healthcare providers work together to agree on payment rates for medical services. The contracts we negotiate determine how much your insurance carrier will pay for treatments, procedures and other medical services, including everything from telehealth appointments to surgeries. Ultimately, insurance contracts determine what your plan covers when you visit the health system.
Insurance companies and healthcare providers routinely revisit and renegotiate these contracts. During negotiation, both sides work to balance increasing costs of care with the need for fair compensation.
Successfully negotiating with payers for fair payments can sometimes be challenging. It's possible for healthcare providers to receive only minimal payment increases that do not adequately cover the costs of care. Without fair reimbursement, we can’t reliably deliver the high-quality care our patients deserve and count on.
When these negotiations occur, if an agreement cannot be reached, you might hear terms like “contract termination” or “out-of-network.” On occasion, healthcare providers and insurance plans may terminate a contract. As a result, that healthcare provider would be considered out-of-network and patients would face higher out-of-pocket costs for care – or have no choice but to seek care elsewhere.
Our commitment to you
Your well-being is our top priority. We make every effort to effectively negotiate with your insurance plan to ensure you can maintain access to the care you need. Our goal is to maintain strong partnerships with all insurance carriers to minimize any disruptions to patient care.
We understand that the notion of insurance negotiation may sound concerning; however, these discussions are a normal part of how healthcare works. Our team is committed to keeping you informed and to ensuring you have access to the care and services you need.
If there is a significant change that could affect your coverage, we’ll communicate with you promptly. We are dedicated to making the insurance and billing process as simple as possible.
Enroll 365 can help you choose a plan.
What you can do
If you have questions about your coverage, you can contact your insurance carrier directly for detailed information about your plan. Our financial advisors are also happy to help you. In Kansas City, call 913-588-7850 or email FinancialCounselor@KUMC.edu. In Great Bend, call 620-791-5054 or email GBC-FinancialCounselor@KUMC.edu.
At the health system, your health and well-being are our top priority. We are committed to working with your insurance company to ensure you receive the best care possible.
Frequently asked questions
General insurance coverage questions
Find answers to common insurance questions.
Questions about insurance negotiation
Get help with insurance plan termination.
For details on insurance plans for which the health system is in network in the Kansas City area, visit KansasHealthSystem.com/Insurance.
For details on insurance plans for which the health system is in network in Great Bend, Kan., visit GBRegional.com.
Speaker 1:
It's common to feel anxiety about healthcare cost. To ease those concerns, let's break down how health insurance works so you can focus on your care, and so there are fewer surprises when the bill comes. In general, health insurance pays for some of your care and you pay for a portion as well. For instance, if you have an office visit for, let's say, foot pain, you may be responsible for a copay. This is a fee set by your insurance company that helps cover the visit. The copay may not cover additional tests, such as blood work or X-rays. Usually, whether you pay for these additional services yourself out-of-pocket depends on whether you've met your annual deductible. That's the total amount you must pay for healthcare in a given year before your insurance begins to pay. If you've met your deductible, you'll pay a portion or a percentage of the additional cost.
This is a predetermined rate called coinsurance. The ratio may be, for example, 80/20 or 70/30, with you paying the lower percentage and the insurance paying the higher amount. If your doctor suggests surgery, you'll want to know the cost up front. First, make sure the surgery provider and the location are in your network. Consult your insurance company's website or your care team to confirm. If they're not in-network, you may pay more to see this provider at this location or be required to choose options within your network. As a general rule, all healthcare services are more affordable for the patient when performed in-network. On the MyChart app, use our cost-estimate features. This tool is key to providing no-surprise billing, which is your right and the right thing to do. The estimator asks for the location where you'll have the surgery and your insurance plan.
It then gives you a good faith estimate of the cost. You can also call our patient financial services counselors who can answer your questions. After receiving your care, you may get a bill by mail or in your MyChart patient portal. It will break down the charges from your doctor in the hospital and will specify what you pay and what the insurance company pays. You can pay your bill online, by phone, by mail or in person. We're committed to making the financial and payment process as simple as possible so you can focus on the most important thing, getting well and staying well.