Negotiations can be a tricky balance for spine surgeons who want to get the most from payers.
Two spine surgeons discuss their approaches to payers in 2024.
Editor's note: Responses were lightly edited for clarity and length.
Question: What strategies are you using for payer negotiations in 2024?
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: For the most part, dealing with payers remains a very leveraged gamble. We are doing the best we can to avoid dealing with payers by doing more direct patient care. Payers are still trying little maneuvers like recouping for cases done three years ago that they already underpaid. I am not sure you can negotiate with a crocodile. Payers have little to no pressure to behave, nor play by their own rules. Many patients cannot afford direct pay, but it does offer a way forward. My hope is at some point, HHS and the FTC will do the right thing and enforce existing laws on these payers, and take away their antitrust exemptions so that they can be regulated like every other company.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Eliminate any confusion when seeking approvals in procedures and coding. If appeals are necessary, then careful discussion and modality-based substantiation is utilized. Attempts at delayed post-operative denials is the new mantra, and this is accomplished with rapid resubmissions and clarifications if needed.