When a Payor said, “This is a competitive offer,” Providers had little ability to challenge that assertion. Without comparative rate data, they were left to choose between accepting the terms or risking network disruption, patient loss, and financial instability.

Veteran negotiator Kelly Drosihn shared with Blake Madden of Hospitalogy how insurers have been known to stretch negotiations to the breaking point, with Payor executives only returning calls at 5:00 p.m. on the eve of Thanksgiving or Christmas, hoping to catch hospital leaders distracted or desperate to close the deal. Negotiations have often been treated like a game, with Payors having better information, more time, and less urgency to close. 

One After Transparency client, the Family Practice Associates of Lexington (FPA), located in Central Kentucky, had to navigate this game for years and nearly lost everything in the process. Despite maintaining a full patient panel, they faced flat revenue and rising costs. The primary culprit for the disparity between patient volume and income was the low reimbursements they were receiving from their primary Payor, a large national insurance company. 

Compared to the large health systems in their market, FPA was being drastically underpaid for the same procedures. And while they had long suspected this, they didn’t have the data to back it up. Every time they raised concerns, the Payor responded with the same refrain: You’re being reimbursed fairly. You’re in line with the market. FPA couldn’t prove otherwise, and the Payor seemed to be counting on that. 

After years of stonewalling, FPA began considering the unthinkable: terminating the contract. Walking away from a major Payor meant sending patients elsewhere and risking more financial strain. But staying the course felt just as unsustainable.

Then FPA partnered with After Transparency, who helped them verify trends in their data that supported the extent to which they were being underpaid. They finally had access to clean, actionable reimbursement data that showed exactly how far below market their rates were. With that proof in hand, FPA was able to renegotiate its contract without a costly legal battle and ultimately secured a double-digit increase over two years on codes that were impactful to the practice. More importantly, they walked away empowered, with proof that even small providers can level the playing field when armed with the right data.

FPA’s story is one that Payors don’t want Providers to hear, but it’s a new reality that Providers can’t afford to miss or ignore. Thanks to regulations enacted in 2023 and reinforced in 2025, negotiated rates are now public, and Providers no longer have to be in the dark. For the first time, Providers can see what Payors are paying their competitors. They can negotiate with proof of their position. 

But access to this data in its raw form is not where the advantage lies. These machine-readable files are massive and often messy. They have been known to exclude payments, fees, or other arrangements. Many are missing physician group identifiers. Others are formatted in ways that make meaningful analysis nearly impossible. This data is powerful, to be sure, but you still need to know how to use it correctly. That’s where having the right people and tools comes in.

As Hospitalogy summarized, “For the provider orgs working with the right people who know what they’re doing, they’re now realizing they’re sitting on a goldmine of dealmaking leverage for better rates with actionable data.”

Hospitalogy adds an important warning: “You NEED to incorporate payor price transparency data - and its future iterations - into your future strategy planning in order to future-proof your operations.”

Their urgency stems partly from the fact that Payors are already using this data in negotiations, and they’re counting on Providers not to. In a KFF Health News report, a Blue Cross Blue Shield executive openly acknowledged using transparency data to ensure their rates remain competitive with other health plans. And according to the Medical Group Management Association, “9 of 10 Payors use [this] data in negotiations with Providers.” 

One surprising reality in this new world of data transparency is that many vendors positioning themselves as trusted advisors to Providers are also selling transparency data to Payors. They’re playing both sides, with no concern for how this alignment with Payors undercuts their Providers.

At After Transparency, we believe that who you align with matters. Our loyalty is to the organizations delivering care and to the financial sustainability that care requires. We will not support both sides of the same negotiation.

As Founder Pete Brumm has explained: “Every aspect of payor pricing data has historically been marked by secrecy, assumptions, and incomplete information. Providers have been kept in the dark and at a disadvantage. Our goal is to leave those black-box practices behind and replace them with transparent ones — where providers finally have reliable, defensible support.”

Since 2023, After Transparency has built its platform and client experience around disciplined data validation, pattern identification, and strategic application. Operating less like a data vendor and more like a managed care insights partner, we handle data complexity so Providers can negotiate with confidence, and finally win the reimbursement game. 

If you’re ready to explore what’s truly possible or simply want an informed conversation about the possibilities available to your organization, connect with our team today. Come discover the After Transparency difference. Reach out to us here.  

While you’re at it, join the thousands of healthcare professionals who already get expert analysis on healthcare M&A, strategy, finance, and markets. Subscribe to Hospitalogy, created by Blake Madden, at hospitalogy.com.