What are Insurance Panels?

Are you interested in getting on insurance panels, but not sure where to start? You’ve come to the right place. In this post, we’ll navigate through the steps you need to take to get credentialed with insurance companies.

An insurance panel is a group of therapists (or doctors) who work with an insurance company to provide services to enrolled clients. The process of getting on an insurance panel is known as getting credentialed. During this process, the insurance company determines whether or not to accept you onto their panel of providers. You’ll need to prove that you’re qualified before you’re invited to join. Each insurance company operates its own panel. So, if you want to work with multiple insurance companies, you’ll need to get credentialed with each insurance company separately.

The Pros and Cons of Getting on Insurance Panels

There are definite benefits to joining an insurance panel. But there are also a few drawbacks that you’ll need to at least consider before applying. Let’s go through them all now: Con: The Waiting Game If you accept self-pay clients, you get paid almost instantly, either through cash, credit card, PayPal, or some other legal tender. You certainly don’t have to wait weeks, or sometimes months, before you’re paid. But with a third-party payer, not only do you have to wait until you’re paid, you also have to jump through a lot of hoops (paperwork) to get paid. Pro: The Insurance Company is Your Referrer Perhaps the biggest reason to get credentialed with an insurance company is the built-in referral. You won’t have to put in so much time marketing your private practice. While I wouldn’t suggest that you abandon marketing altogether, you’ll at least have one source of constant referrals. The insurance company does the advertising for you. You’ll be listed on their website as a preferred provider. And many clients who are insured start on their insurance website first. Con: Lack of Freedom When you’re credentialed with an insurance company (or several), you’re bound to the rules that each company has set forth. For example, you’re not able to set your own rates. The insurance company will pay what they choose and you’ll have to accept it. This also means that you’re likely to get paid less per client than you would if you were able to set your own rates. Pro: Some Clients Prefer Going Through Insurance The average American lives paycheck to paycheck, and can’t afford to pay out of pocket for mental health. Unfortunately, mental health is still considered a “luxury” service by many people. Some clients prefer to use insurance to mitigate their out of pocket cost. If you accept insurance, you’ll be able to work with clients who may not be able to pay for your services without it. Con: Less Privacy Remember how I said many clients with insurance go through their insurer first? Place the emphasis on many and not all. Some clients actually prefer anonymity, especially in matters of mental health. They do not want a third-party payer privy to their mental health. If many of your clients prefer privacy, then it may make more sense to avoid getting on a panel, and instead operate as a self-pay practice. This is another thing to consider: Do you want another party encroaching on your therapist/client privacy? You won’t have much say if you get paid through a third-party payer. Pro: Legitimacy Getting credentialed can boost your perceived legitimacy. Right or wrong, some prospective clients gravitate towards therapists who have gone through the rigorous process of insurance credentialing. To some, this extra step proves that the therapist can be trusted. The process of getting credentialed may be worth exploring if you’re a newer therapist and still building your clientele.

What’s the Process of Getting on an Insurance Panel?

Getting on an insurance panel requires two things: paperwork and patience. You’ll fill out an exhaustive amount of pages in each application that you submit. Then, after submitting the application, you’ll wait. You’ll fill out another application, and then wait again. Finally, if all goes well, you’ll learn whether you’ve been invited onto the panel or not. Let’s break it down step-by-step. The first step is to decide which insurance company you’d like to work with. Finding the right insurance company can be tricky. It’s a good idea to rely on the recommendations of other therapists that you trust to guide you to the right insurance company for your private practice. Look through all the insurance companies that serve your state. Then, research each insurance company. When researching insurance companies, also focus on price. What is the insurer’s reimbursement policy? What’s required for reimbursement? Do an Internet search for their credentialing requirements by searching for “insurance company” + “credentialing” (i.e. Cigna + credentialing). Once you’ve settled on the insurance companies you’d like to apply for, go to each insurance company’s website and click on a button that takes you to provider services (it’ll usually say “provider”). From here, they’ll give you instructions on how to get credentialed. You’ll need to follow the instructions for application on each individual insurance company’s website. Some insurance companies will have you start the process on their website. Others will ask you to start your application on CAQH. No matter what, you’ll eventually need to set up an account on CAQH, and your all-important CAQH number.

What is CAQH?

CAQH stands for Council of Affordable Quality Healthcare. This non-profit coalition was formed by insurance companies to create a single, uniform application for credentialing providers. More than 100 managed care companies use CAQH to process applications. Most major insurance companies verify your self-reported data through a CAQH. That’s good news because if you’re applying to more than one panel, you’ll only need to fill out your CAQH application once. While setting up your CAQH, you can grant authorizations to any insurance company that you’d like to view your information. You can start setting up your CAQH here. The CAQH application is pretty lengthy and laborious. You’ll fill out between 20 to 50 pages (50 pages for Medicare). While you’re able to print off and complete your application via paper, it’s best to do it online. Submitting online is faster, and more reliable (there’s no paperwork to lose). Don’t forget to keep a copy of all of your documents. Also make note of who you spoke to and when you submitted your paperwork.

Following Up is Important

Don’t let your application fall into purgatory. Follow up on your application with the insurance company’s provider relations department. Insurance companies rarely, if ever, follow up on applications—remember it’s you who wants to get listed, not necessarily the other way around. It’s your responsibility to make sure that they’ve received your application and are processing it. If it’s not processed in time, your application may expire or time out, and you’ll have to go through the entire grueling process all over again. Follow up after you’ve submitted the application and then call every few of weeks until you’ve been accepted (or rejected). Keep in mind that some companies require that you wait for 45 days before contacting them. The entire process can take between two to four months. If you have to appeal, it can take up to six months or longer. So, if you’re hoping to get credentialed before opening up your private practice, plan ahead.

Should You Hire a Credentialing Company?

There are benefits to hiring someone else to do the paperwork and follow up, but of course, it’s not a free service. You’ll have to decide for yourself whether it’s worth a few hundred dollars per credentialing to avoid filling out the lengthy applications required. Another option is to ask for a therapist to mentor you through the process. Ask someone who’s on a panel that you’re applying for. Maybe they can provide you with helpful pointers.