This is the third of a 3-part series to help ease your way to getting approved as a preferred provider with insurance companies. The series began here.
If you’ve already engaged in the double-jointed, back-bending, hoop-jumping application process for getting onto insurance panels as a preferred provider only to be told that their panels are “full,” I do have some thoughts to share with you.
Although I no longer work directly with managed care, I know of a couple of ways you might be able to attract their attention in a positive way.
If your application is denied, you can ask for a “single case agreement” when appropriate.
If you are able to justify to an insurance company why a client of yours should be allowed to continue working with you even though you are out of network, it is entirely possible for them to grant you a “single case agreement” to be considered “in network” for only that client.
Reasons that might justify such an agreement would be those that address the unique needs of your client and the cost / benefit needs of the insurance company.
Perhaps your client has minimal skills in maintaining relationships.
If trust comes hard to her, your relationship with her may qualify as a positive and extenuating circumstance.
Or, if your client is mid- gender reassignment and there are no other professionals appropriately trained to address this client’s immediate needs, you may be the only logical choice.
These are only two examples of hundreds that are likely to exist.
Keep your eyes open and ask.
It costs you very little if you are sure that you want to be on a particular panel of preferred providers.
Then, if the insurance company is pleased with your work, it is also possible for them to easily transition you to being one of their preferred providers.
It’s a matter of massaging those warm relationships with Provider Relations as you go and proving your worth to them.
Remember, it’s much less expensive for the insurance company at that point to add you to their provider list list than it is to begin the credentialing process all over again with a different therapist whose work is unknown to them.
If your application is denied, a different strategy might be to affiliate with another provider who has already been accepted as a preferred provider.
Insurance companies prefer to work with groups – even when the individuals in those groups are only loosely affiliated with each other.
By affiliating with a group of providers or an individual provider who has been accepted onto an insurance panel, you are increasing the perception of your value to those same managed care companies.
And, finally, it’s important to remember that the needs of managed care change.
Stay abreast of those changes by monitoring on a regular basis the individual companies that you are most interested in.
Put them on your calendar to contact every few months.
Give Provider Relations a call, show up at the local Employee Assistance Professionals Association to meet and get to know them.
Most of all, keep your name and face in front of them and let them know that you are eager to join and support them!
And, if you have additional suggestions for getting onto preferred provider lists after initially being rejected, please leave them below!
As usual, your posts are very helpful – thank you! I like your idea of affiliating with an existing provider. I am in the process of doing just that with an accepted provider in an under-served area. Southern California seems to be pretty saturated so working out of the under-served areas seems like a great way to get on the panels and receive more referrals.
Excellent, Tanya! So glad I can help!
By affiliating with an existing provider, you are, in part, gaining the track record of that provider. It lends some credibility to you who might otherwise be a virtual stranger to the insurance company.
Best wishes on your journey!
Tamara, can you explain more how being affiliated with a group helps? I am with a group private practice and not able to get new individuals on panels due to the panels being closed. I get the usual response, “send in a resume” but they never reply back.
Hi, Maureen! Thanks for asking the question!
is no secret that managed care prefers to admit groups of providers to panels rather than individuals. It’s less labor intensive – and, thus, less expensive – for them to vet multiple people from the same group. I also suspect that managed care feels that they are also “sharing” their liability as they take on additional providers under that group. After all, it’s likely that the group practice has, to some extent, already vetted those therapists. Managed care will still check to see if a potential provider meets their minimum criteria but it is also likely that they will not hold them to their own standard of “need” in a particular geographic area.
Maureen, I hope we have some managed care insiders here in our online community that can verify or otherwise speak more to this issue. However, I would encourage you to make sure that the group practice you are with has already been approved as providers. If that is not the case, then I would suggest that if your colleagues in the group are in agreement that they want to pursue this application to be providers, you contact Provider Relations with each managed care company and inquire about how to expedite that application. It is sometimes the case that by submitting all applications at one time under the group name, you are able to sidestep some of the red tape.
Best wishes on the process! I hope you’ll drop back in often to chat and share what you learn long the way!
Can you affiliate with another doctor but still be able to bill under your own TIN?
Hi, Perry! Yes, that’s possible because “affiliating” with someone is not a legally defined term.
Dear Tamara,
I appreciated your clarity in you 3 part article. I viewed your article because I am trying for the second time with a new Insurance company. I am trying to succeed this time! I need every tip and hint I can get. I am mentioning to this Particular Insurance company our well known certifications, I will mention to them other Insurance carriers that we are paneled with. I am also going to stress to them our out-of -the-ordinary times of operation and many locations available. Thanks for your advice and expertise!
Hi, Pam! You are so welcome and I appreciate you dropping in to share your strategies, too. Please do let me know what comes of your efforts this time ’round. It’s encouraging to others when they hear that persistence really does count.
Good luck with your efforts!
Hi Tamara,
Thank you for all the wonderful information! My wife and I are both counselors and looking to get credentialed. What are your thoughts on getting credentialed independently vs. both getting credentialed under our group name, Peak Clarity Counseling. The group is really just a name and website at this point. I don’t mind setting it up as a business, but I’m wondering about down the line – will the insurance panel paperwork be more of a headache if we go one route vs. the other. We’re also considering medicaid.
Hi, Dustin! It’s good to meet you!
I assume you are asking about getting credentialed to work with insurance companies (rather than obtaining a license or certifications). At this point in your work, having your group credentialed is no more or less complicated than each of you getting credentialed independently.
However, should you choose to later bring on additional therapists, your group credential will likely shortcut their efforts to get credentialed.
In a different scenario, should you and your wife choose to individually get credentialed, you will each have the ability to practice in different locations that do not fall under the group name Peak Clarity Counseling. For example, if you want to open a different practice or subcontract under another practitioner or organization, you would be able to do so.
Dustin, I hope you’ll drop back in to join the conversations here at Private Practice from the Inside Out. I look forward to hearing what you and your wife decide to do and when your website gets launched.
That is exactly the information I needed. Thank you Tamara!
🙂 So happy to help, Dustin!
Hi, this is such great information. Thanks for putting it together. I’m almost finished with my license. I am not even sure I want to take insurance. I’ve done pretty well in private practice without it.
But I want to look at all my options and be ready to go if/when I do want to concider panels.
You mentioned a resume a couple times and I was wondering if you had any advice on what you would put on your resume for the insurance panels that would be helpful beyond a typicial resume.
I am part of a terrific network of therapists in my area and we meet three times a year, so I have a request into them about who they would suggest I attempt to get panelled with. And I’ve looked at some companies online applications but there isn’t anywhere that I see so far to include a resume. Do they send you paperwork to fill out after you have submitted your application?
Thanks for the great website and information!!!
~Mary
Mary, I’m so glad you find this information helpful! If you don’t let me know what is and isn’t helpful, I can end up blogging about things that are totally useless to you guys! And that is never my goals!
You are always wise to consider all your options and to keep as many different options open to you for as long as possible. While I’m totally happy with being 100% a fee-for-service practice, I know that that’s not everyone’s desire or path.
These days most managed care companies do require applications online rather than ask you to submit a stack of papers to them. (In the 1980’s and ’90’s when I entered the field, it wasn’t uncommon to sent an inch-thick manilla envelope to each company with your application inside!) Some companies will still allow you to attach or cut / paste your resume into the online application. When they do, I encourage therapists to include a cover letter and also their resume highlighting their managed care-friendly skills, knowledge-base, and achievements.
Hey there! I’m here in Denver starting a practice while working full time. Do you think it’s worth using a program to help get you accepted on panels?
Hi, Lindsay! Welcome to Private Practice from the Inside Out.
I get asked this question all the time and the short answer is “Nope.”
Not unless you already have a full practice and you can make more money by seeing your clients than by filling out paperwork.
I don’t know what program or service you are thinking about hiring or purchasing but, truthfully, it’s not rocket science.
No one is going to be able to sell your strengths better than you can.
To make it easy on yourself, gather all the info you need for all of the companies you plan to apply to and do them all at once – copies of your license, copies of your resume, copies of your certifications, etc.
Most of the managed care companies want the same type of info.
Then, complete the applications assembly-line style unless you are applying online.
Save copies of everything you submit.
You need proof that you sent what you sent.
Or, better yet . . . skip the panels and commit to being a cash-pay-only practice!
Either way, best wishes on your journey!
Hi Tamara,
These articles are very helpful! My business partner and I are opening a private PT practice and have been denied by insurance credentialing. I am writing the appeal letter currently. Do you have an example/basic template for writing an appeal?
Thanks!!!
Oh, Kelly! Congrats to you on opening your practice!
I can’t tell from this if you are opening a practice in physical therapy or you are opening a part-time mental health practice.
Nevertheless, the letter of appeal to a managed care company basically contains the same things – a persuasive rationale that will benefit the insurance company’s clientele – who is not your clientele, by the way.
I need to write an article on this.
But, for now, I would suggest that you get clear about the motivation of managed care – to save their customers’ money.
You can help them do that (and possibly get them to add you to their panels) by explaining to them how your qualifications and experience help them better meet their own needs.
Highlight your training and experience and how it serves their underserved populations.
Insurance companies often can’t find enough therapists who are qualified to work with sex offenders, those with chronic and severe mental illnesses, substance abuse, children, families, couples, ADHD, etc..
Additionally, you’ll want to mention any relevant credentials you may hold or obtain that might underscore your qualifications to work with clients at a higher level.
Use only language that is manage care friendly; avoid language of psychodynamic therapies and progressive technologies that are not supported by significant bodies of peer-reviewed research.
And, finally, if / when you do receive denials, ask why your applications were declined.
Many / most? Managed care companies will not panel individuals or practices with less than 5 years of full-time experience in the field.
I hope this helps!
Best wishes on your journeys!