Specialty Medical Group

Driving $800K in Revenue Growth: How PayrHealth Helped a National Specialty Provider Expand Access and Improve Women’s Health Outcomes

About the Client

Since 2017, this multi-state specialty medical group has offered an innovative, office-based procedure to address chronic pelvic pain—a condition that affects millions but remains underdiagnosed and misunderstood. Their patented protocol targets the underlying causes of pain, such as inflamed pelvic nerves and muscular dysfunction, providing a new care pathway for patients often overlooked in traditional models.

The Challenge

This provider struggled to gain broad payor recognition. Due to misconceptions about their unique model—often mistaken for conventional physical therapy—payors were hesitant to contract or offer appropriate reimbursement. Despite strong clinical outcomes, they lacked the internal bandwidth and positioning expertise to break through these barriers.

Their goal was clear: expand access to care by establishing contracts with major payors and securing rates that reflected the value of their specialized services.

The PayrHealth Solution

PayrHealth was chosen for the team’s extensive expertise in payor contracting and ability to clearly articulate this provider’s unique value proposition to insurers. PayrHealth’s data-driven approach and deep understanding of the healthcare landscape made us the ideal partner to overcome payor misconceptions and demonstrate the clinical and economic impact of their services.

Strategic Approach

PayrHealth’s strategy focused on four key areas:

1. Education and Advocacy
Using published research and actuarial studies, PayrHealth developed a go-to-market narrative that clearly demonstrated the clinical and economic value of the client’s services—particularly in reducing opioid use, absenteeism, and unnecessary ER visits.

2. Targeted Negotiations
The team identified key stakeholders at major payors and led structured negotiations, securing favorable contracts and expanding in-network access across multiple states.

3. Clinical Policy Modernization
PayrHealth partnered with the client to advocate for updates to outdated or misaligned policies—ensuring coverage decisions aligned with current best practices in chronic pain treatment.

4. Strategic Partnerships
Facilitated connections with telehealth platforms and fem-tech providers to strengthen referral pipelines and improve care coordination.

Results

• $800,000 Annual Revenue Lift: A single renegotiation resulted in a 23.5% fee increase.
  
• Expanded Access: New contracts with major national payors increased patient reach and improved continuity of care.
  
• Reversed Rate Cuts: PayrHealth successfully reversed a significant reimbursement reduction by a large payor, averting a major financial setback.

Contact PayrHealth

Having negotiated over 50,000 contracts in all 50 states, PayrHealth has the knowledge and expertise to secure highly competitive rates and terms for your contracts, no matter how outdated they are or how big a player the payor is. We also have a team with over 40 years of experience in management of revenue cycles and helping you close down on lost revenue through your practice. Contact us today to learn more.