Imagine receiving a letter from your health insurance company informing you that the doctor you’ve seen for years, or the hospital you’ve always relied on, may soon be out-of-network. Suddenly, you face the very real possibility of losing access to the providers you know and trust. For patients and families, these notices can raise difficult questions: will I have to find a new doctor? What happens to my upcoming appointment or ongoing treatment? And why is my access to care suddenly at risk?
The answer often lies in a process most Americans have rarely seen or thought about: contract negotiations between hospitals and health insurance companies (“payers”). Hospitals and health systems regularly negotiate agreements with insurers that establish the terms under which they provide care to patients covered by those plans, including how hospitals are reimbursed for their services. These contracts, which often last several years, also determine whether a hospital or physician remains part of an insurer’s network.
For hospitals, these negotiations are about securing reimbursement rates that reflect quality care delivery, from staffing and medical supplies to equipment and essential services. But insurers are increasingly pushing health systems to accept rates that fail to recognize the value of the care they provide. When the two sides cannot reach an agreement, hospitals and physicians can be removed from the insurer’s network, putting patients’ continued access to their preferred providers at risk.
The consequences can be significant. Patients may have to find a new provider, delay an appointment, or interrupt a treatment plan. Even when an agreement is ultimately reached, the uncertainty surrounding these negotiations can create anxiety and confusion for patients and their families.
The Patient Impact
A recent HarrisX poll conducted on SKDK’s behalf in September underscores just how important these issues are to Americans. Nearly half of adults, about 45 percent, say they have experienced a negative coverage or network issue involving their insurer and health care provider in the past three years. Among those who experienced an issue:
- 38 percent say the issue caused stress or anxiety
- 30 percent delayed or canceled an appointment or procedure
- 29 percent experienced a disruption in treatment or continuity of care.
These challenges are reported more frequently by Black and Hispanic Americans, younger adults, and people living in urban areas. For patients already navigating a complicated health care system, losing access to a trusted doctor or hospital can create another barrier to receiving care.
The poll also makes clear just how much Americans value their relationships with their providers. Nearly 8 in 10, or 79 percent, say it is very or extremely important that their preferred doctors or hospitals remain in-network. If their preferred hospital or health system left their plan’s network, 26 percent would switch insurance plans. And these consequences extend to insurers as well. Nearly two-thirds of Americans, or 62 percent, say they would view their insurance company less favorably if it removed their preferred hospital or health system from its network.
For hospitals, these findings reinforce an important point: patients want to maintain access to the providers they trust, and they recognize the importance of those relationships. Health systems have a strong case to make about why fair reimbursements matter and how these negotiations directly affect their ability to maintain access to quality care and communities they serve without delay.
Trust must be part of the strategy
The same poll found that Americans trust their doctors and health care providers more than their insurance companies when it comes to information about coverage and access to care. 34 percent cite doctors and providers as their most trusted source, compared with 18 percent who cite their insurer.
That trust is both a responsibility and an important advantage for health systems navigating difficult negotiations. Patients want clear, timely, and straightforward information about what a negotiation means for their care and what steps they need to take. And when negotiations become public, hospitals need to be prepared to explain why fair reimbursement matters, what is at stake for patients, and how they are working to preserve access to quality of care.
This is particularly important as insurers pursue more aggressive tactics to strengthen their negotiating positions, from sending notices directly to patients warning of potential network disruptions, to launching ad campaigns that place blame on hospitals for stalled negotiations. Some are also using looming contract deadlines and the threat of removing providers from their networks to increase pressure. Hospitals need to be better prepared to make their case to patients, employees, community leaders, policymakers, and the broader public.
That is the ethos behind why we started the Payer Negotiation Practice, bringing together our expertise in health care communications, public affairs, research, and reputation management to help health systems navigate these increasingly difficult negotiations.
Our work helps health systems:
- Develop a clear negotiating communications strategy and messaging that explains what is at stake.
- Engage patients, employees, clinicians, community leaders, and policymakers.
- Prepare for public scrutiny and rapid response.
- Communicate clearly before, during, and after negotiations.
- Protect their reputations, strengthen public trust, and make the case for fair reimbursement.
Payer negotiations will always involve difficult questions, but hospitals should not have to choose between securing the fair reimbursement rates they need to provide quality care and maintaining the trust of the communities they serve.
For patients who receive notice that their trusted doctor or hospital may soon be out-of-network, the stakes are immediate and personal. Health systems must be prepared to explain what is happening, why fair reimbursement matters, and what they are doing to preserve access to care. Because ultimately, these negotiations are about more than reimbursement rates and contracts: they’re about ensuring patients can continue to access the doctors, hospitals, and care they know and trust.
Sarah Lyons is a senior vice president and member of the firm’s Payer Negotiation Practice.
About the survey: The HarrisX poll was conducted online September 28 and 29, 2026, among 1,176 U.S. adults. Results were weighted to reflect the U.S. adult population.