Dear provider relations representative,

This letter is to notify you that our contract with your company is nearing term or has expired. [Provider name] has provided valuable services for your insured members during the term of the existing contract. According to our records, we have served approximately [XX] patients with [insert insurance carrier name] from [contract onset date] to [current date].

We would like to request a meeting to discuss fee schedule increases for the coming contractual term. As you are probably aware, a number of both commercial and governmental payers are increasing fee schedule allowances to offset healthcare organisation’s operational costs.

Further, our office has implemented a number of quality improvement measures which we believe will result in improved care to your insured members:

[Healthcare practice to customise the following bullet points to more accurately detail your quality improvements or create more appropriate descriptions]

Clinical performance measurement implementation

Patient satisfaction improvements (use of surveys, new locations, longer hours, organisation of support groups)

Staffing improvements

Technology improvements

% of fees according to the postcode on consumer affairs that shows I am below the postcode fee acceptable in this postcode. [customise this to match the bottom]

Yours sincerely,

[Name]

[Office TITLE]

[Optional request for additional disclosure]

It appears that our office was not provided with the applicable fee schedule related to this contract or the applicable internal procedures for bundling, coding and outlier application which affect reimbursement. Therefore, we request that this additional reimbursement information be sent to us immediately. Disclosure of the information will allow us to more fully prepare for our upcoming discussion regarding this contract. As of 20XX, the average fee at the 70% is and we are unable to accept the fees you are providing which are in the 40%. [customise this area]