Brace Health co-founder and CEO David O’Hara joined Nathan Shields on the Private Practice Owners Club podcast to discuss a question many practice owners face: what would give an insurance company a reason to reconsider your reimbursement rates?
In “How AI Can Help Negotiate Higher Payer Rates, with Brace Health,” David shares our perspective on preparing a practice-specific case and using AI to support the research behind it.
Listen to the full episode and read the transcript.
Episode artwork courtesy of Private Practice Owners Club.
Make the case around the payer’s incentives
Rising expenses explain why a practice wants better reimbursement. In the conversation, David argues that a stronger negotiation also explains what the payer could lose if that practice’s participation changes.
He focuses on two considerations: access to care within the payer’s network and near-term costs. A practice’s location, clinical specialties, or appointment availability can make that argument more concrete. The useful question is how those details affect members in that particular market.
Where AI fits
David describes using AI to help research nearby providers and identify differences that may matter to a payer. The aim is to turn local information into a clearer explanation of the practice’s value.
That research supports the negotiation; it does not decide the outcome. The practice still needs an accurate case, the right payer contact, and a clear request.
Choose the payer and the ask deliberately
The episode also covers why the lowest-paying insurer is not necessarily the best place to start. David suggests considering which payers account for meaningful patient volume and where a rate change would matter to the practice.
He discusses keeping the initial request focused on reimbursement rather than combining it with changes that may require different decision makers. Nathan and David also explore the practical work of finding a contracting contact and following up when an initial message receives no response.
Why this work matters to Brace Health
Our work on payer negotiation grew from conversations about the rates our billing customers were receiving. This episode shares what we have been learning about helping independent practices explain their value to payers.
It is a conversation about preparation and persistence, not a promise of a rate increase. We appreciate Nathan inviting David to share that perspective with the Private Practice Owners Club community.
Listen to David’s conversation with Nathan Shields.
Interested in exploring this for your practice? Learn about Brace Health’s payer-negotiation program.