This is the second of a 3-part series to help ease your way to getting approved as a preferred provider with insurance companies. The series began here.
Managed care companies receive hundreds of applications from licensed mental health professionals every year who are wanting to become preferred providers.
That’s why it’s important to make your application stand out in a positive way to the professionals in Provider Relations that will be evaluating your credentials and experience.
Here’s a few tips that I’ve learned over the years that may help you rise to the top of the pile.
Tip #1 – Focus on your own efficiency and your ability to save on costs.
Managed care came into existence as a reaction to offset the rampant financial abuses in health care.
As such, the primary goal of these companies is to reduce costs of health care.
The care of clients comes second.
Make sure that your application speaks to managed care’s concerns and not just your own.
Tip #2 – Location makes a difference. (And, not just for the reasons I stated here.)
If you can provide services in an under-served area, you are more likely to be admitted to a preferred provider list.
If you currently provide services in a therapist-saturated market, you may want to consider adding a second site to your practice.
By indicating that you are available to provide services in an under-served area for just a few hours each week, you make yourself much more desirable to managed care companies.
(And, the good news is that once your are “in” on the panel, you can typically relocate your services without losing your place on the provider lists – even across state lines!)
Tip #3 – Highlight second languages that you are fluent in.
Your unique expertise is what will get you on the list so don’t forget to highlight an ability to speak a foreign language every chance you get.
Tip #4 – Special hours can set your practice apart.
Most therapists work 8 a.m. – 5 p.m..
If you can offer late or early hours or are willing to work on weekends, mention them on your application.
Those “special” hours can be a way to expedite your entrance into the world of preferred providers.
Tip #5 – Special populations require special knowledge.
Don’t indicate that you “work with everybody.”
That’s not what managed care is looking for.
Instead, if you have advanced training and experience working with a specific population or two, emphasize this.
Populations such as geriatrics, children, GLBT, deaf clients, etc. can open doors for you with managed care.
Tip #6 – Advanced training and credentials count.
Although experience definitely counts, proof of skills via advanced training and credentialing make you much less of a risk to insurance companies and much more desirable to them, too.
Track your professional development and flaunt it in your application.
Do you have other tips that can help other licensed mental health professionals get on insurance panels?
If so, I hope you will leave them below.
And, on Monday, I’ll share some tips in Part 3, the final part of this series, How to Get On Insurance Panels as a Preferred Provider, for those of you who have had your applications denied.
What I would like to know is how to get around the “We’re full” and “we’re closed to new providers” lines.
So glad you asked, Jill! It’s coming on Monday’s post!:)
Great blog – thank you! Do you have any tips on speeding up the process with credentialing? I have many clients that are just waiting for me to be approved so they can start.
Welcome, Tanya, to Private Practice from the Inside Out! And, thanks for dropping in to chat tonight. You ask an interesting question. I’ve read stats in the past that indicate that the number one reason for applications not being processed in a more timely manner are because therapists have failed to provide all of the required info – they forget supporting documentation or they leave questions on the application blank. That’s why I started off this series by saying “Get organized!”
Having said that, I think it’s also important to note that the application process tends to be a lengthy one. Be prepared for that and spend that time networking and making the connections you need to strengthen your relationships with Provider Relations. By the time those applications are processed, you can have someone on the inside asking for you! Now THAT might speed up the process!
By the way, Tanya – I’ve asked my colleague who used to work in managed care to drop in here if she gets an opportunity to share her thoughts about speeding up the process. Not sure if she’ll make it but you might want to check back in periodically. I’m sure we have other readers here in our community that can also contribute to this conversation.
Thank you Tamara! I may need to be more patient, but I will spend more time with provider relations personnel.
You are so welcome, Tanya! I know you are eager and hungry to get clients in the door but you have to remember that EVERYONE read that energy as desperation . . . and that’s NOT what managed care needs to see.
I checked out your website and noticed that you have a terrific platform via your blog to begin establishing and building your authority. I can’t tell what your niche is . . . possibly balance? Whatever it is, Tanya, your blog is a terrific place to start curating and creating information related specifically to your niche. That way, when the insurance companies get around to checking you out, there will be evidence online of who you are and what you have to offer! And, that very well could put your application at the top of the pile! I wrote a post here about other things you can be doing while you are waiting for clients to find you.
What you and Jill (and other therapists) need to know is that contracting with insurance companies might feel like a security blanket to you, but they are rarely if ever going to reliably fill your appointment book or the coffers of your private practice.
Hi Tamara! In Part 2 of your (excellent and helpful) series. When you say “managed care,” are you using those words as interchangeably with insurance panels? I think of managed care as HMOs. Insurance panels may include some HMO coverage, but also PPOs. I am a bit confused. Thanks for the clarification!
Bethany
Hi, Bethany! Welcome back and thanks for asking. I should have noted in my first post that there was a time when insurance companies were separate from managed care companies. However, over the last two decades managed care has moved into virtually every insurance company. I can’t even name an insurance company that does not fall under the realm of managed care today. Health Maintenance Organizations (HMOs), Preferred Provider Organizations and panels (PPOs), and Employee Assistance Programs (EAPs) are all different forms of managed care. So, while historically speaking insurance companies and Managed Care Organizations (MCO’s) were different entities, today they are not. And, in this series, I did use these terms – “insurance companies” and “managed care” interchangeably.
Hope this helps with the confusion!
Yes, that is very helpful! Thank you!
Bethany, thanks for saying so. It’s always helpful and encouraging to hear back from you guys to know if I’m on target or way off base! Have a good week!
just wanted to share that i was sent a general letter from Aetna stating that there were enough providers for my area. i followed up and called the person in charge of my area, and explained that I was a young male child/adolescent provider and did not think that there were too many of us around. she called back about 2 weeks later and stated that i would be given an exception and my application would get pushed through.
long story short, never hurts to ask, and highlight one’s specialty area(s) in getting through “closed” networks
John! Thanks so much for dropping in here to share your experience! I completely forgot to mention in my post that male therapists . . . especially male therapists who work with children are in short supply! Absolutely critical that you guys are aware of the shortages and that you play to those shortages. And, kudos to you for taking the initiative and being persistent in your application process. There are as many loopholes for getting onto provider lists as there are therapists . . . . You just have to be persistent and think out-of-the-box – and those are the traits that any client is going to prefer anyway!
Hello!
I just received the same decline letter from Aetna and was feeling discouraged. It was nice to hear that someone had a favorable response from them when they called as that was my plan. Hopefully I am just as convincing! Any advice would be appreciated. Thanks
Hi, Danielle. I’m so sorry that you just got a letter declining your application with Aetna. If you haven’t tried, I would contact Provider Relations to see if you can learn more about how you could have strengthened your resume. Depending on who you talk to, you may or may not get some useful feedback. It’s worth a try.
The second thing I would recommend is that you read the third part in this series. I have provided some suggestions to help once your application is denied.
And, finally, I’m hoping others will chime in here with other ideas to support you in this process. I hope you’ll drop back in, Danielle, when you finally make it on to the panel!
Hi ,
I am trying to figure out with all this fantastic information that you have provided whether there is a cost to the providers practice to accept insurance? is there a cost associated with the credentialing process? is there a quota that needs to be met? yikes!!
How do I get on panels that are closed? I received a denial letter from Aetna. Should I reapply when the school district shifts from Blue Cross to Aetna in the fall? Should I pay a credentialingbservice? I just opened a private practice office in March and so far have made the rent but not a profit. Please help a new counselor, LPC.
I just saw John’s post. Thankyou so much and I will try that as well.
I am wondering if it is worth the investment in hiring a credentialing company?
In my opinion, it is not, Christina. I’ve seen a lot of these companies promise the moon and deliver dirt. Applying to get on the panels is not difficult. What is difficult is realizing that you still need to market your practice to earn a steady income and you’ll earn a fraction of what you could if you were a fee-for-service practitioner.
Thank you so much for sharing you expertise! I am hoping to slowly start a part time private practice and hoped to be able to get credentialed on a few panels before I actually open for business. Is it possible to do without actually having a physical location yet? Thanks for your help!
Hi, Jenny! Welcome to Private Practice from the Inside Out and congrats to you on slowly starting your practice!
I’m happy to support you on your journey!
To the best of my knowledge, I do not believe that any managed care panel will admit you to them before you have a physical location.
However, with distance therapy continuing to gain acceptance and momentum, you might want to take the time to check with individual paneling applications.
I suspect this requirement will be (and may already be going away).
In fact, I’ll pitch this question to some of my colleagues and drop back in here to share if I find evidence that some are changing their policies on this. I hope you’ll take the time to do the same!
Hello! Do I need to have graduated from an APA accredited school to be on insurance panels such as Aetna, Bluecross, etc once I become licensed as a clinical psychologist?
Thank you in advance!
Hi, Eric! Welcome to Private Practice from the Inside Out!
Managed care and insurance companies don’t bother to look at what school you graduated from. Instead, they look to the state that you are licensed in. So, if California says that you are educated properly to be licensed by that state, then the managed care / insurance company would not take issue with your training.
I hope that answers your question! (And, thanks for taking time to drop in today!)
considering a master program in counseling, what credentials most do insurance companies accept the most or at all when being able to bill? LMFT over LPC, LMHC etc trying to plot the best course of action that will benefit me from a business sense down the road?
Hi, Carla! What a great question to be considering at the beginning of your program rather than at the end!
The short answer is . . . it depends.
Rather than focusing on what insurance companies will accept, I would encourage you to consider which discipline feels like the best fit for you personally.
Geography rather than insurance companies often dictates which licenses are favored; the insurance companies tend to fall in line with those “preferred” licenses.
For example, in the State of California, Professional Counselors were almost unheard of up until a few years ago; instead, LMFT’s were favored there along with Psychologists and Social Workers.
In Colorado, LMFTs are still struggling to gain the acceptance that Psychologists, Professional Counselors, and Social Workers have had for years.
Regardless of what the insurance companies accept today, there’s a good chance their criteria will be different in 4 years.
By focusing on the discipline that you fit best in, you’ll maximize the likelihood of being a success whether you work with or without managed care.