Should you accept Insurance?

Do you have questions about insurance? You know, the type of questions that you don’t really want to ask your fellow therapists for fear of ridicule? As you’ve probably heard before, there are no stupid questions—especially when it comes to insurance. The world of insurance is very cavernous and murky, and sometimes it’s hard to navigate through it all. But we’re here to help. In this post, we’ll tackle those burning questions that you probably have about insurance but didn’t want to ask. Don’t worry—every therapist who’s ever considered accepting insurance has asked these same questions. Let’s get started with the answers.

1. What are the benefits of working with insurance companies?

There are many great benefits to working with an insurance company. Here are two of the best reasons to join an insurance panel:

A constant source of referrals.

Marketing your private practice can feel like a full-time job. When you network with an insurance company, you get to plug into another, more exclusive source of referrals. If an insured customer needs a therapist, they’ll likely turn to their insurance company’s website first. Because the insurance company will list your name and contact information on their website, you’ll receive special promotion to their customers. Plus, other medical professionals within your same insurance network may refer their patients to you.

Serve a diverse group of clients.

Sometimes, the cost of mental health can be a heavy burden on the client’s budget. It’s not your fault—you have to eat too. But, for some prospective clients, mental health can be a luxury even though it’s actually a need. By accepting insurance, you’ll be able to see clients who may not be able to pay for your services out of pocket. You’ll be able to help people who desperately need your services but can’t afford them. Your practice won’t just accept clients on their ability to pay. Often, in rural or economically depressed areas, accepting insurance allows you to serve more of the population without relying on a sliding scale or simply giving away your services for free. You began your private practice to help as many people as possible, and accepting insurance will allow you to reach a wider group.

2. What is credentialing?

Credentialing is the process of getting on insurance panels. It’s how insurance companies qualify you to provide services to their customers. The process of credentialing starts when you fill out an application to join the insurance company as a provider. From there, you’ll need to complete a second step, which is to fill out a CAQH ProView application. Most major insurance companies use CAQH (which stands for Council for Affordable Quality Healthcare) to verify applicants. You’ll self-report all of your information through this online form, and the insurance company will refer back to it during their credentialing process. The bad news is that the CAQH is a lengthy form. When printed out, it’s at least 30 pages long (more if you’re applying for Medicare). But the good news is that you only need to submit the CAQH once, unless something changes (i.e. you move addresses). You can open up this CAQH application for any insurance company to see, which is helpful if you plan to apply to multiple insurance companies. If and after the insurance company approves your application (which can take some time—more on that later), you’re considered “credentialed” with that particular insurance company. You can now provide services to their customers. If you choose to work with other insurance companies also, you’ll need to start the entire application process over again (minus the CAQH).

3. How easy is it to get paneled?

The answer is… it depends. Getting paneled depends specifically on two things: your location and your specialty. It’s not uncommon for an insurance company to close panels because they simply have too many providers. This is the reason why location matters. If you serve a rural or even a suburban area where there is less access to mental health, it may be easy for you to get paneled. However, in urban areas where the community has more options for therapy, getting paneled is often tougher. If you want to join a panel that may be closed or almost full, you can stand out by your specialty. Perhaps you offer a service that the insurance would like to provide but doesn’t have representation for. Your niche service can persuade insurance companies to fit you into their panels.

4. How do I determine which insurance panels to join?

The easiest way to figure out which insurance company to network with is to ask around. You most certainly know other therapists in your area. Ask them which insurance companies they’ve joined and what their experiences have been. Most paneled therapists will have a definite opinion on their insurance company, and will readily give it when asked. A few questions to ask:

How well does the insurance company pay compared to how much you could make without accepting insurance?
Does your insurance company reimburse you quickly?
Have you experienced any hassles with the insurance company?

5. How long does it take to become a preferred provider?

Getting credentialed takes even longer than filling out the CAQH application. Expect to wait between three to six months for the insurance company to make their final decision. And, brace yourself—that decision can be “no”. It’s a good idea to stay in contact with the insurance company the entire time. Most insurance companies have a provider relations department that you can contact. Contact this department after turning in your initial application and check up on the status of your application at least twice a month (every 15 days) to make sure that your application is still processing and hasn’t gotten lost—it happens!

6. What are the drawbacks of working with insurance companies?

So, we discussed the benefits of working with an insurance company. Here are a few of the biggest reasons why you might be tempted to run screaming the other way:

You must accept lower pay.

An insurance company decides exactly how much they’re willing to pay for a specific service, and they’re not going to make exceptions for you or anyone else. You’ll be working for less than you could make as a self-pay practice.You’ll need to be okay with that because you have no other choice.

You work for the insurance company and not your clients.

When you accept insurance, you’re effectively becoming an employee of the insurance company. They pay you and you must abide by their rules and regulations. Likewise, you must diagnose your clients in order to get paid. This obviously decreases the level of privacy you can provide your clients. It also means that you’ll need to “label” clients. The insurance company will then decide what your client needs—not you. You will have to provide the client with the course of treatment prescribed by the third party payer. The insurance company can limit what services you’re able to provide and may even prevent you from offering other treatments to your clients.

7. What should I do on my insured client’s first visit?

On your insured client’s first visit, you should do the following:

Take a photocopy of their insurance card and driver’s license to keep on file.
Ask them to fill out an intake form. This form authorizes you to keep their signature on file in order to process claims with their insurance company.
Confirm the insurance is still up to date (you’ll do this on the first visit and on every subsequent visit).
Collect the copay or deductible.
File the claim right away—the same day if possible. File electronically through the insurance company or through an insurance clearing house.

8. How soon will I get reimbursed?

The insurance company usually has 45 days to pay or reject the claim. Generally, you’ll need to wait at least 30 days for payment, if everything goes smoothly. If the insurance company has a question about the plan of treatment or decides to reject, you could spend weeks trying to collect payment—or worse. Many therapists have to write off claims that the insurance company refuses to reimburse. The reimbursement process is long and tedious, and definitely is one of the drawbacks with accepting insurance. Be sure to follow up on claims. You may spend hours each month doing so, but it’s better than not getting reimbursed at all.

9. How do I terminate my agreement with insurance companies?

What if you join a panel but then realize that managed care is not for you? You can terminate your agreement, and fortunately, it’s not as painful as getting credentialed. Every insurance company has their own set of termination requirements, but just about every company requires that your termination notice be in writing. After submitting your termination notice, you’ll usually have around 90 days before the insurance company officially terminates your contract. Use this time to prepare your insured clients. Have a plan in place for these clients. Will you transition them into self-pay or will you refer them to another in-network therapist? Ideally, you’ll answer these questions before you decide to terminate your agreement. If your insured clients want to continue working with you as self-pay, ask them to sign an updated disclosure statement now that you no longer accept insurance.

10. Can I accept insurance without getting credentialed?

Yes, but proceed with caution. You are able to accept insurance as an “out of network” provider, assuming that the insurance company pays benefits to such providers. However, it can be a lot more hassle than it’s worth. One big reason is that, as an out of network provider, the insurance company is not obligated to pay you. They have no contract with you, and many a claim has been rejected because of it. An alternative to this is to put all of the burden of collecting reimbursement on the client. In this method, the client pays you upfront and then you provide the client with a “superbill”. A superbill is a detailed invoice of your session (including ICD-10 and CPT codes) that the client can submit to their insurance company. The insurance company will almost never reimburse the client for your full fee, especially because you’re an out of network provider. It’s more likely for the insurance company to reimburse at a customary rate of 50% your normal fee. However, some clients like the idea of offsetting their full payment by getting partial reimbursement through their insurance provider. If you do go this route, make sure that your clients know the risks as well as the benefits. It’s important that your client understands that he or she is still responsible for full payment, even if the insurance company declines reimbursement.

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Administration Inside/Out Billing Financial Improvement