Key Impacts
Cigna PHP Rate: Increased by 100% — rate doubled through market-data-backed negotiation
Aetna Better Health PHP Rate: Increased by 80.8% — largest Aetna gain confirmed by Transparency in Coverage benchmarking
Cigna IOP Rate: Increased by 45.5% — driven by CPT-level state market percentile analysis
3 Payers Renegotiated: 6 rates successfully renegotiated across IOP and PHP programs in a single engagement
Objective:
A specialty behavioral health provider operating Intensive Outpatient (IOP) and Partial Hospitalization (PHP) eating disorder programs knew their rates were below market — but without objective data, had no defensible basis to prioritize payers, set targets, or hold their position under pushback. With 62% of their 13-payer portfolio running on Single Case Agreements, rate instability was structural. Neolytix ran a two-phase engagement: a feasibility study grounded in federal Transparency in Coverage data that revealed exactly what competing IOP and PHP providers in the state were being paid by CPT code and county, followed by active contract negotiation with Aetna Commercial, Aetna Better Health, and Cigna. Armed with named competitor benchmarking and a prioritized negotiation roadmap, Neolytix secured rate increases across all three payers — including a 100% PHP rate increase with Cigna and an 80.8% PHP rate increase with Aetna Better Health — with multi-year terms and annual escalators embedded to protect gains over time.
