Complete Story
06/10/2026
“Take It or Leave It”: When Provider Contracts Stop Being Negotiation
By Timothy J. Munderloh DC FIACN | Member, AAC Reimbursement Fairness Committee
Not long after finishing my training, I signed my first insurance contract. I remember thinking there must be room to negotiate — I had credentials, I had outcomes, I had patients who needed access to care. I asked the representative whether the rates were flexible. The answer was polite but unmistakable: these are the standard terms. Take it or leave it. That conversation has repeated itself, in different forms, across decades of practice. I eventually stopped asking.
“If thousands of independent contracts produce nearly identical rates, something other than negotiation is happening.”
What most chiropractors don’t realize — what I didn’t fully appreciate until recently — is that the premise itself may be wrong. Healthcare contracting is supposed to involve good faith negotiation. Rates are supposed to vary based on provider qualifications, outcomes, geography, and patient demand. That is what a functioning market looks like. For a Doctor of Chiropractic, the market does not function that way.
Using AI-enabled analysis of machine-readable file (MRF) data — now publicly required under federal transparency rules — we can actually measure what is happening. Across most provider categories, contracted reimbursement for the same billing codes shows meaningful variation, exactly what you would expect in a negotiated environment. But for chiropractors, that variation nearly disappears. Across thousands of independent contracts, the rates are nearly identical.
That pattern is difficult to reconcile with individualized, good faith negotiation. What it suggests instead is the use of standardized, externally imposed pricing structures — and an industry-wide assumption that providers will simply accept what is offered.
The legal implications are real. Section 2706(a) of the Public Health Service Act prohibits health plans from discriminating against providers acting within their lawful scope of practice. Federal policy consistently emphasizes that healthcare markets should promote access, competition, and patient choice. Contracting systems that suppress rate variation and eliminate meaningful negotiation move in the opposite direction — and raise serious questions about whether compliant market conditions are being maintained.
The downstream effects are not abstract. When reimbursement is structurally constrained and providers are denied real negotiating power, fewer chiropractors remain in-network. Access to conservative, evidence-based care shrinks. Patients — particularly those on Medicare Advantage, Medicaid, or lower-income plans — face fewer options and longer waits. The absence of negotiation at the contracting level becomes a barrier to care at the clinical level.
The AAC Reimbursement Fairness Committee is actively analyzing MRF data, engaging regulatory processes, and building the evidence base needed to challenge these patterns. But the strength of that effort depends on your participation. I am asking every Arizona chiropractor to re-examine the assumption that their contracts are non-negotiable — because that assumption may be the most powerful tool the system has against us.
If a contract cannot be negotiated, it is not functioning as a contract. It is functioning as a control.
And ultimately, it is our patients who bear the cost.
REFERENCES
- Public Health Service Act §2706(a), Provider Nondiscrimination. hhs.gov
- CMS Transparency in Coverage Final Rule (CMS-9915-F), Machine-Readable File Requirements, 2020. cms.gov
- OptumHealth Care Solutions / UnitedHealthcare Arizona Chiropractic Fee Schedule, effective 6/1/2016.
- AMA 2023 Prior Authorization Physician Survey. ama-assn.org
- NCQA Utilization Management Standards (UM 1–UM 4). ncqa.org
