Negotiating with Payers

For many of us, payer negotiations feel distant—something handled “somewhere up the chain,” far removed from the day-to-day work of helping patients. But here’s the truth: nothing shapes our practice more than the reimbursement rates and contracts negotiated on our behalf.

Reimbursement determines who we can serve, how much time we can spend with them, what services we can sustainably provide, and ultimately whether our practice can survive/thrive. And while therapists may assume this is a job for billing or leadership, every OT and PT needs a foundational understanding of how payer negotiations work.

In this one-hour live webinar and podcast course, we’re joined by two leaders with deep, real-world expertise:

• Chad Herzog — VP of Operations at Aroris Health, an organization whose mission is simple and powerful: help healthcare providers get paid what they’re worth so they can focus on what matters most—helping people and improving patients’ lives.

• John Hutchinson, MBA — Co-founder of CARE Counseling (with his wife, Dr. Andrea Hutchinson), a practice acquired by UnitedHealth in 2024. John brings firsthand experience navigating growth, payer relationships, and the business realities that shape modern care.

Together, they’ll break down what every clinician should know about payer negotiations, how reimbursement impacts clinical practice, and what therapists can do to advocate for sustainable care models.

1. You will be able to recognize the basic components of payer negotiation for OT.

2. You will be able to identify the current trends in payer negotiation for OT.

• Intro

• Discussion

  1. John, can you tell me the story of how payer negotiations became important to you at CARE Counseling?

  2. Chad, tell me your story! What drew you to such a specific role?

  3. Ok—tell me the basics of payer negotiation. Who talks to whom, and what typically gets decided?

  4. Can you share a real example of how a well-negotiated contract improved patient access or clinical outcomes?

  5. As OTs and PTs, it feels like we are losing reimbursement battle after reimbursement battle. Why is that?

  6. One problem we have is simply scale. Even though we are high impact, we just don’t drive as much revenue as other specialties. And we tend to work in small outpatient practices. What are our options with such a disadvantage?

  7. What data matters most in negotiations—clinical outcomes, patient satisfaction, utilization metrics? What should practices be tracking now to strengthen their position?

  8. What are the most high-impact things someone like myself at OT Potential—or our state and national associations—can do to support practice owners in this process?

  9. What trends do you see on the horizon that we need to pay attention to—things that could either help or hinder this process?

  10. For therapists listening today—what’s one shift in mindset that could help them better navigate the realities of reimbursement?

• Live Q&A

• Closing

• Value-based pricing: a potential solution to difficult pricing discussions and payers’ negotiations

• Developing evidence that is fit for purpose: a framework for payer and research dialogue

• Why Evidence Generation Should Matter to Payers and How They Can Help

It is the policy of OT Potential to disclose any financial and non-financial interest the provider or instructor may have in a product or service mentioned during an activity. This is to ensure that the audience is made aware of any bias of the speaker.

OT Potential pays guest speakers an honorarium for their participation, either directly or to an institution of the speaker's choosing at their request. We invite guests whose expertise often comes from practices, programs, or building products in their field. Where a speaker has a financial interest in the subject of a course, we disclose it below so you can weigh it for yourself.

OT Potential's interest in this topic: We have no financial stake in this topic.

Speaker interests: Chad Herzog is VP of Operations at Aroris Health, which sells insurance contract negotiation and payer enrollment services to healthcare providers — the services discussed in this course. This is also disclosed in the episode.

John Hutchinson co-founded CARE Counseling, a practice acquired by UnitedHealth in 2024.