The health care negotiator

A professional health care price gladiator says negotiating conditions seem to be about the same as they’ve been for the past 20 years, when he first climbed into the arena.

Prices continue to be all over the place, and the providers’ willingness to bend on price also continues to be highly variable, according to Bruce Roffe, president of HHC Group.

“You can never know what a provider’s going to do if we’ve never called them before,” Roffe said in a recent interview.

HHC can help a health insurer, self-insured health plan, workers’ compensation plan or other entity review medical bills, manage cases and dicker with providers over the cost of out-of-network care.

The firm can also look at care from another angle, by acting as an external independent organization. When HHC fills that role, it helps patients and coverage providers determine whether a plan or prepaid health care services provider, such as a health maintenance organization (HMO), is providing enough of the right kind of care.

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Some providers hope HHC will help them get paid more quickly, Roffe said. Others prefer to stick to their billed prices and turn any unpaid bills over to collection agencies.

When HHC is conducting negotiations over out-of-network bills, the firm uses a combination of commercial physician services price data and its own proprietary data. 

Roffe said the reasonableness of the commercial “reasonable and customary” price figures varies from case to case. For HHC, newer numbers are better than older numbers. Numbers that come from the prices plans actually paid are better than numbers based on what the providers billed.

Providers in competitive markets tend to be more flexible than providers who have rural markets all to themselves.

In most markets, providers tend to be tougher about prices early in the year and looser later.