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Insurance paneling is a real chore.
After all, you went through graduate schooling to help people. Not spend dozens of hours trying to get paneled (also called credentialed).
But you want to help people, so you go through this necessary evil.
Luckily, we’re making it easier than ever for therapists to get paneled with insurance. By the end of this blog, you’ll know:
Dive into this guide for a thorough exploration of insurance paneling, and take the first step towards expanding your practice's reach and accessibility.
Deciding whether to become paneled with insurance companies is a significant decision for any therapist. This choice impacts your practice's operations and also your accessibility to clients who have insurance. But there are also good reasons why therapists forego insurance.
To help you decide, check out these pros and cons of insurance paneling:
Increased Client Base: Insurance paneling opens your practice to a larger pool of potential clients who prefer (or need) to use their insurance benefits for therapy. This can lead to a steadier stream of referrals and appointments.
Reduced Financial Burden for Clients: By accepting insurance, you make therapy more accessible and affordable for clients who might otherwise be unable to pay out-of-pocket. This can significantly widen the impact of your services.
Feeling of Security: Being part of an insurance panel often guarantees a more consistent and predictable stream of new clients. Though your earning potential will be more limited, it can be (or at least feel) more secure than private pay.
Not a Bottleneck: Just because you take insurance doesn’t mean you have to use it. If any cash-pay clients come your way, you can collect your full rate, and insurance is still there for other clients who need it.
Complex Credentialing Process: The process of getting credentialed can be lengthy, requiring extensive paperwork and patience. This can be intimidating to start and burdensome to continue, especially for those just starting their practice.
Lower Reimbursement Rates: Insurance companies often reimburse at rates lower than the typical out-of-pocket fees. This means you might earn less per session than you would from private-pay clients.
Administrative Overhead: Working with insurance entails dealing with claims, billing, and potential denials, which can increase your administrative workload or require you to hire additional staff.
Note: Thrizer can handle claims submissions and claims denials on behalf of your out-of-network clients. Learn more here.
Restrictions and Limitations: Some insurance plans impose restrictions on the number of sessions, types of therapy covered, or require extensive documentation and justification for treatment plans. This can limit your flexibility in providing care. Not to mention it can be time-consuming.
Benefits Depend on Your Location: It’s been observed by many therapists that paneling is very beneficial if you’re serving a rural population. But in population centers like New York, Phoenix, and Los Angeles, insurance reimbursements may not be sustainable. Ask therapists in your area what their experience has been.
Weighing these pros and cons is crucial in deciding whether insurance paneling aligns with your practice's goals and values. While the prospect of reaching more clients and providing affordable care is appealing, it's important to consider the administrative and financial implications.
A word of caution: paneling with insurance should not be seen as a way to avoid marketing your practice. Sure, insurance credentialing can bring referrals to you. But if you want to have a consistently full caseload(s) and grow your practice, you’ll need to learn marketing. Or outsource it to a professional.Â
Remember, the choice to panel or not is deeply personal and should reflect your unique situation and aspirations as a therapist. Now let’s get into the nuts and bolts of paneling.
So, you want to be an insurance-paneled therapist? If you’ve decided to get paneled, this is the section you’re looking for.
As they say, pre-planning now can save you a lot of time and effort later. So we’ve curated this checklist of items and documents you should have (or obtain) BEFORE applying to an insurance panel.
Professional Liability Insurance: Ensure you have current professional liability insurance with adequate coverage for your practice.
State License: Have a valid, active state license to practice therapy in your state. Make sure there are no restrictions or sanctions on your license.Â
National Provider Identifier (NPI): Obtain a Type 1 NPI number. This unique identifier is required for all healthcare providers, including therapists. Apply Here.
Tax Identification Number (TIN) or Social Security Number (SSN): Decide if you will bill insurance using your SSN or a TIN (if you have a business entity).
Curriculum Vitae (CV): Update your CV to include your education, licenses, certifications, and relevant professional experience. Important: Make sure all dates are formatted as MM/YYYY! Otherwise your application may be rejected.
Proof of Advanced Trainings and Certifications: Have copies of your advanced traingings, licenses, and any additional certifications handy. These can improve your chance of acceptance. For example, if the insurance panel needs an eating disorder therapist and you are licensed as one.
CAQH Profile: Complete your profile with the Council for Affordable Quality Healthcare (CAQH), a common step required by many insurance panels. Ensure it's fully updated and re-attest every few months.
References: Prepare a list of professional references who can vouch for your clinical skills and professional integrity.
Once you have all of the above, getting paneled is pretty straightforward.
Research and Select Insurance Panels: Begin by identifying which insurance companies have a significant presence in your area and are used by your target client population. For detailed advice, check out our blog on the best insurance panels in 2024.
Contact Insurance Panels for Application: Reach out to the provider relations or network management department of each insurance company. Request paneling information and an application. Some may require a preliminary interest form before providing the full application.
Submit Application and Required Documents: Fill out the application forms meticulously, providing all requested documentation, including items from your checklist. Accuracy and completeness are critical to avoid delays.
Credentialing Process: After submitting your application, the insurance company will begin the credentialing process, which involves verifying your qualifications, background, and references. This process can take anywhere from 60 to 120 days, sometimes longer.
Contract Offer and Negotiation: Upon successful credentialing, the insurance company will offer you a contract. Review the terms carefully, including reimbursement rates and service obligations. Negotiate if necessary, focusing on terms that align with your practice's needs and sustainability.
Sunk-Cost Fallacy: You may feel the need to accept a low reimbursement rate, thinking along the lines of “I’ve spent 9 hours getting this far, I should just accept it and move on.” Don’t let this type of thinking get you. You are a valuable service provider. If the contract doesn’t fulfill your business requirements, you can walk away and not sign.
Finalize and Sign the Contract: Once you are satisfied with the contract terms, sign and return the contract. You’ll then receive information on how to bill the insurance company and other pertinent details to begin seeing insured clients.
After successfully navigating the insurance paneling process, maintaining your paneled status is key to ensuring uninterrupted service for your clients and steady revenue for your practice. Staying credentialed is not a one-time event but an ongoing requirement. Here’s how to manage it efficiently:
Regular Reattestation:
Insurance panels require therapists to reattest to their information periodically, typically every four months. This process involves confirming that your professional details (licenses, certifications, practice addresses, etc.) are up to date. Failing to reattest can result in being dropped from the panel, which could disrupt your ability to bill for services. Nightmare scenario- you may not get paid for services you’ve already provided.
Set Reminders:
While insurance panels usually send out notices when it's time to reattest, it's crucial not to rely solely on their notifications. Proactively setting a recurring reminder in your calendar or phone ensures that you never miss a reattestation deadline. Consider setting the reminder 1-2 weeks in advance of the typical reattestation period to give yourself ample time to review and update any necessary information.
Keep Documentation Updated:
Make sure all your documents and credentials are current. This includes your professional liability insurance, state license, NPI number, and any other required certifications or accreditations. Keeping these documents updated will simplify the reattestation process and prevent any delays or issues.
Panel Tracking Spreadsheet:
Consider using tools and resources, such as our panel tracking spreadsheet, to keep track of when you’re due for reattestation. Also track any changes in insurance policies, and your contracts' terms. This tool can help you manage your insurance paneling responsibilities efficiently and reduce the administrative burden.
Engage with Your Panels:
Maintaining an open line of communication with the insurance panels you’re affiliated with can be beneficial. They can provide you with updates, help resolve any issues promptly, and offer guidance on optimizing your paneling benefits. Regular engagement can also alert you to opportunities for renegotiating your contract terms based on your experience and changing market conditions.
By adopting a proactive and organized approach to maintaining your credentialed status, you can ensure your therapy practice continues to thrive and serve clients through their insurance benefits without unnecessary interruptions or administrative hassles. Better yet, have your virtual assistant (VA) manage this task.
Wrapping up our guide on insurance paneling, we've covered everything from deciding to panel to maintaining your status. This guide aims to simplify the complex process of insurance paneling, helping you reach more clients and secure your practice's future.
Remember, the journey to insurance paneling is significant but rewarding, paving the way for greater access to mental health services. Be tenacious and organized and you’ll get there.
Once you are paneled with one or a few companies, let Thrizer handle the insurance billing. We’ve helped hundreds or therapists across the U.S. save time, earn more money, and grow their practices.
Check out our pricing details here, and request a free product demo here.
What is the difference between paneling and credentialing?
Paneling and credentialing are closely related processes in healthcare. Credentialing is the verification of a provider's qualifications and credentials (e.g., education, training, licenses). Paneling, on the other hand, is the process of being accepted onto an insurance company's panel, allowing the provider to be reimbursed for services. Essentially, credentialing proves you're qualified, while paneling makes you an approved provider for insurance reimbursement. Sometimes these terms are used interchangeably to talk non-specifically about the process of working as a therapist legally.
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What are the cons of paneling?
The cons of paneling include a complex and lengthy credentialing process, lower reimbursement rates compared to private pay, increased administrative tasks related to billing and claims, and potential restrictions on therapy sessions and types of services covered by insurance. These factors can limit flexibility in providing care and increase the operational burden, making it challenging for some therapists to balance clinical work with administrative demands.
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Why is paneling so expensive?
Paneling incurs costs due to the extensive administrative work involved in the application and credentialing process, ongoing compliance requirements, and the management of insurance claims and billing. These activities often necessitate additional staff or third-party services, leading to higher operational expenses. Furthermore, the time and resources dedicated to navigating insurance policies and procedures can detract from a provider's capacity to deliver care, indirectly adding to the cost.
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This blog post is provided for informational purposes only and is not intended as legal, business, medical, or insurance advice. Laws relating to health insurance and coverage are complex, and their application can vary widely depending on individual circumstances and state laws. Similarly, decisions regarding mental health care should be made with the guidance of qualified health care providers. We strongly recommend consulting with a qualified attorney or legal advisor, insurance representative, and/or medical professional to discuss your specific situation and how the laws apply to you or your situation.
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