Taking on private insurance is like learning to eat healthy.
At first you aren’t sure you want to do it. You’ve heard how hard it can be and so you’re on the fence. You enjoy your freedom and don’t want to be tied down by all the rules. It seems like so much effort. It feels too hard.
But there’s this little voice in the back of your mind saying what if? What if eating healthy could be the best thing for you in the long run? So you take the first steps in learning to eat well. You find yourself frustrated with the effort, energy, and resulting mood swings that come from being outside your comfort zone. You continue to question if it is worth all the hassle. You have a couple meltdowns.
Eventually, with persistence, you find your groove. You’re noticing it takes less effort to eat healthy. You’ve found success in having a plan in place, it feels more effortless now.
The journey of adding insurance to your private practice is a lot like learning to eat healthy.
The same emotional rollercoaster. The same doubts and frustration. The same growing pains. And in the end, insurance can contribute to the overall health and well-being of your business, allowing it to thrive amidst COVID-19 and beyond.
So let’s take a look at some of the myths and practical tips to navigating insurance in private practice.
Myth #1: The Panels are Closed
It’s possible that the panels are closed, especially when we understand that insurance data on their providers isn’t very accurate or up to date. It isn’t uncommon to hear that providers listed in directories are retired, deceased, or not taking new clients. So how successful would a member (client) be in finding a qualified provider? Encourage potential clients to reach out to their private insurance to express their concerns and difficulties. Sometimes this works to open up a panel for credentialing of additional providers in hearing that their members can’t find the services they need.
What can you do as a professional?
· Name your Niche: Highlight your specialties and justification for being approved as a provider. If insurance finds you are providing a service their members want, they could agree to move forward with credentialing.
· Be Persistent: Follow up with closed panels to see if things change over time. Your persistence may pay off if you catch them in the optimal window where they are taking new providers!
Myth #2: Payment is Poor
I recommend to fellow providers that we all find a way to make peace with not being paid what we are worth. Insurance panels will report that they generate their pay structure based on comparable professionals in your area and thus, believe they are offering a competitive rate. Regardless of what they pay, is it still important to you to serve a particular population? Is it worth the effort to help people who need to use their insurance to access services? If you’ve answered yes to these questions, don’t give up on insurance just yet! Panels continue to evaluate rate of pay on an annual basis and I’ve seen the rates of reimbursement improve over time. There’s hope that they will continue to evaluate and increase rates every year.
Professional Pointers
· Do your Research: What services does each insurance panel reimburse for and at what rate? Interview colleagues to better understand their experiences with certain panels.
· Renegotiate as Needed: Identify the process for renegotiating your rates once you’ve been credentialed as a provider. It doesn’t mean you will automatically get what you’re asking for but it could spur insurance to take another look at rates for all their providers in hearing from you and others that a rate increase is desired.
Myth #3: Billing is Unbearable
I agree with you that billing can be a headache. More so when we had to mail in claims or submit them by hand on CMS1500 forms. The good news is that billing has been streamlined, saving time and headaches for providers everywhere! What has streamlined billing over the past ten years? Electronic Health Records (EHR). Popular options like SimplePractice, TherapyPartner, and TherapyNotes have billing processes built in, eliminating the middleman clearing house and auto-filling some billing information based on your calendar appointments to save you both time and effort as a busy clinician.
Professional Pointers
· Create Templates: Streamline your process even further by creating required templates in your EHR like a credit card form for collecting copays and a Mental Health Assessment to justify a clinical diagnosis required to bill each service.
· Understand Compliance: Identify compliance requirements based on your insurance contract. Most require a diagnosis resulting from a formal intake, progress notes, and treatment plans for providers to remain compliant and pass an audit.
Myth #4: I’ll End Up Working for Free
There is understandable fear that clinicians could work for free. Insurance panels could take money back if providers make a billing error or if the member isn’t actually covered by an active insurance policy at the time of service. Combine this with confusion about what insurance plan the member/client actually has and the random names for varying plans under bigger names like Aetna and United, it’s no wonder providers feel reluctant to jump on the insurance bandwagon. It’s in your best interest to create a system and process for verifying insurance from the first contact with a client you’d like to work with. It is also in your best interest to bill regularly so you can catch any errors in a timely fashion. After all, it’s even more painful to realize you aren’t getting paid for the last three months in having waited to bill sessions at a later date.
Professional Pointers
· Anticipate Delays: Budget your business with anticipation of delays in payment. Most insurances take 2-3 weeks to process claims.
· Set up EFT: Selecting Electronic File Transfer (EFT) or Direct Deposit of funds will save you some stress in seeing when funds are processed and received in your business account
Insurance doesn’t have to be so stressful. I sincerely and passionately believe that adding insurance clients to your practice will support sustainability and quality client referrals, making your business a healthy one full of growth and long-term potential in offering what you do.
To learn more about adding insurance to your private practice, check out our webinar, Investing in Insurance: Strategies for Private Practice which features more on the 4 Myths and 20+ Tips of adding insurance to your private practice, making it work well for you!