So, are you ready to start your private practice? Congratulations!!
After making the initial decision of whether to accept insurance or not, you then have to decide WHICH insurance companies to credential with.
Deciding which insurance providers to credential with is a very important decision, as it has a significant influence on who your patients are, and what reimbursement you are receiving for your services.
Here are some factors to consider when making this decision:
Patient Demographics: Who is your target patient? Think about who they are and what their demographic is. Then, figure out who your target demographic’s common insurance providers are! If the majority of your potential patients are using a particular insurance, it makes sense for you to consider credentialing with that provider.
Reimbursement Rates: Different insurance providers can offer very different reimbursement rates for the same services. Compare the rates provided by different insurers for the services you offer to ensure you are adequately compensated for your work. Also, remember that while some insurances are willing to negotiate rates, others aren’t. Tip: Other providers aren’t allowed to provide you with their exact reimbursement rates, or they could be in breach of their contract, but they may be able to tell you who some of their best payers are, or what range the payments are in.
Billing and Administrative Burden: Some insurance providers have complex billing procedures that may require more administrative work. Take this into account – it could impact your operational costs.
Network Need: Insurers may be more likely to accept new providers into their network if there is a need for your specialty in your area. For example, do you have any specialties that are rare, or in high demand? Do you speak more than one language? Conversely, if there are already many providers in your specialty in your area, some insurers may not accept new providers. You are typically able to appeal your rejection if your application is declined because the area is closed, and may succeed, especially if you include some of your special and unique offerings in the appeal letter!
Coverage Policies: Review the insurance company’s policies on what services they cover, as well as any restrictions or pre-authorizations that may be required. Some may have limitations on the number of sessions they’ll cover or the types of treatments they’ll reimburse. This is VERY IMPORTANT, because if they deny the claim for one of these reasons, many insurance company contracts do not allow you to then go and charge the visit to the patient.
Speed and Ease of Payment: Look at the insurance company’s track record for paying claims. Some insurers may take longer to process claims or have a higher rate of denying claims. Talking with other providers in your state who work with multiple insurances can help you to identify some of the insurances that might be easier to work with! Do note that many insurance companies vary widely by state!