This is the first of a 3-part series to help ease your way to getting approved as a preferred provider with insurance companies. 
I was scanning emails on one of my favorite online discussion lists, the Denver Private Practice Network, [as of 11-04-2011 known as the Denver Therapists' Network] when I ran across an inquiry from Licensed Professional Counselor, Becky Bringewatt of Mantis Counseling and Coaching Services of Denver, Colorado.
I am applying to [insurance] panels and have not been able to get on because they are full or full for my therapies at this time. I would appreciate any help with this, too.”
I suspect that many of you are struggling to get on insurance panels as a preferred provider. Although I no longer choose to work directly with insurance companies [You can see why here], I know that many of you still choose to do so. In this post, I’m providing the steps you need to go through to apply to become a preferred provider with an insurance company.
Step 1 – Get organized. I can’t stress this enough. Insurance companies are going to want lots of information including . Get organized. If you are going to apply to be on lots of insurance companies, you might as well make lots of copies of your licenses, proof of malpractice insurance, resumes, and other supporting documentation. Just do it now to streamline your process.
Step 2 – Make a list. Insurance companies vary considerably in the amounts they will pay providers. They also vary in how quickly they will reimburse you, how “provider-friendly” they are, and how many hoops you will be required to jump through to obtain reimbursement. That means that it makes sense to be strategic about which insurance companies you choose to be a provider for as well as the order in which you apply. Ask your colleagues who are already preferred providers what their experiences have been with any given company before making that list.
Step 3 – Contact Provider Relations. Call each insurance company that you want to work with and ask to speak with Provider Relations. Every company has someone in this position that can speak frankly with you about their application process. Request an application. They will most likely re-direct you online but this is a good opportunity to start building a human connection. And, while you are at it, ask them what their unique clinical needs are. Every company’s needs are different.
Step 4 – Use your personal contacts. If you’ve already been networking in the field, it’s likely that you have already run across individuals who work in managed care or indirectly with managed care. If you haven’t met those individuals already, now is the time to put that on your networking to-meet list. Employee assistance programs (EAPs) and those employed in provider relations can provide you with shortcuts (like what the needs of that particular company are) and tips (like what most therapists forget to include in the process) for getting your application accepted. Pick their br
ains!
Step 5 – Complete the CAQH. The application process can be lengthy and arduous. Plan on 20-30 page applications for most insurance companies and plan on about 50 pages for Medicare applications. The Council for Affordable Quality Health is an online service that allows you to complete one application that over 100 managed care companies use. That can save you a lot of time so consider complete the CAQH to cut down the amount of paper work (potentially 2000+ pages) in the process. (Check out this guest post on how to register with CAQH.)
Step 6 – Copy everything you include in your application. It is not unheard of for applications and supporting documentation to be lost, misplaced, or actually shredded after it leaves your hands and long before the application process is completed. Make sure you copy everything and keep detailed notes about when, how, and who you talk to in Provider Relations and who said what. It is likely that you will need these notes later on so that you sound competent, clear-headed, and informed.
Step 7 – Create and keep paper trails. I’m all about saving trees and minimizing the clutter that can come with paper. However, communicating in writing with managed care can be your saving grace down the road. I recommend that you communicate by phone or face to face to nurture the relationships that you are developing with managed care. However, always follow up important conversations via email so that you will have a paper trail to confirm your understanding of contractual details and expectations. Honor and the spoken word is not enough.
Step 8 – Submit your application and supporting documentation in a timely manner. You will likely be rejected as a provider if you fail to submit a complete application and respond to any additional requests in a timely manner. Those employed in Provider Relations refer to failures of this nature as “timing out.” In order to avoid having your application rejected solely because it has timed out, you will need to stay organized and efficient and respond to their requests for additional information quickly.
Step 9 – Follow up. Once your application and supporting documentation has been submitted, your job is not done. You should again contact Provider Relations and ask them about the timetable for processing your application. I recommend that you contact Provider Relations at least monthly until you have a final disposition of your application.
On Thursday, I will share with you some of the ways to make yourself more desirable to insurance companies in Part 2 of this series, How to Get On Insurance Panels as a Preferred Provider.
Perfect timing, Tamara! This is exactly what I am working on this week. My practice specialty is working with people living with cancer, chronic and serious illness. Seems most referral sources want to know what panels I am on. Right now, and at this time I am on no panels. Hoping to change that soon! Thanks again!
Best,
Bethany
Hi, Bethany! Thanks so much for dropping in this evening to chat! I love that you know what your niche is – and a fabulous one, at that! And, I just checked out your website and love the image you have of “This is what healing looks like.” Beautiful!
You have no need to worry about not yet being on any panels. That will not count against you at all when applying to be on insurance panels. Good luck with the process! Let me know if I can help in any way!
perfectly timely
Hi, Meira! Welcome to Private Practice from the Inside Out! Thanks for dropping in to chat. I’m glad you found the post useful and hope you’ll be back to add your thoughts to the conversation in the near future.
Another great article! I have a question alongside that: I have applied to multiple insurance panels with a decent mix of acceptances and “we’re not accepting new providers right now”. But there’s one I haven’t heard back from and I cannot seem to get through their automated system or find an email address to ask if I’ve been accepted or rejected! Any tips for getting through to an actual person?
Also, I’ve been accepted as a non-network provider for another company, but same issue: no one has told me what that means, what plans I can accept, or how to file! Help please!! I need advice.
Good morning, Stephanie! Thanks for the RTs this morning and dropping in here to chat.
Hopefully, some of our readers here will have some suggestions for you because I’m just problem solving on the fly this morning. Here’s a few things to try . . . .
1. Leave the names of the companies here. They may be reading, too, or some of our readers may have human contacts that they can share with you to help you get inside the companies.
2. Have you tried just googling the name of the company along with “provider relations”?
3. I know this sounds obvious but . . . you may want to write a good old fashioned letter of inquiry and send it via snail mail. Or, if you have tried that already, send another copy of it by Certified Mail.
4. Contact other professionals who are already working within this system as preferred providers. Ask them how they typically get their own questions answered.
5. And, if you cannot get the company to return your phone calls or respond to your inquiries, as a last resort, you may want to consider filing a complaint – with a parent company, the Better Business Bureau, the National Association of Insurance Commissioners, or the Attorney General in your state.
Stephanie, if you try any of these and have any success, I hope you’ll drop back in here to let us all know and learn from you!
That is a good idea! I didn’t think about Googling Provider Relations, I will try that. The one I can’t find out if I’m accepted into is United Behavioral Health, and I have been accepted as a authorized provider by TRICARE and can file claims but I am not a contracted provider at this time. Not sure what that means or if I would want to become a contracted provider….Yipes!
OK, gang! Can you help Stephanie out? I know there are some stellar networkers on this this list so can you introduce Stephanie to a UBH professional or two? Know the ins and outs of TRICARE? Share the info right here and we’ll all learn from YOU!
Tamara, I can’t believe you are posting this now. All I’ve been doing all week is sending in credentialling paperwork, hehe. If anyone knows how I could get a human response from anyone at the medicaid office in Georiga, that would be a great help.
Hi, Jill! It’s good to have you back here!
OK, gang, can you help Jill out? She’s needing a human contact at the Medicaid office in Georgia!
(And, Jill, I hope you’ll drop back in with the name and contact info for that person when you get it.)
I am also interested in knowing about any insurance companies that you just love to work with, good provider relations, pay in a timely manner, etcc. and who takes people with less than two years licensed.
Great question, Jill! And, I can’t remember . . . are you tweeting these, too? Gotta love Twitter for getting hooked up with this kind of information!
I haven’t tweeted this yet, but that’s a great idea.
Hi Tamara: Very good list for folks attempting insurance panels. I would add one thing and that’s to make sure the panels know of any specialties you might have and make sure to include that in your applications. Also, don’t rule out EAP panels. While some of them don’t pay as well as the heavy hitters, it’s a great way to build up client base, many of whom will choose to stay with a therapist once they start seeing someone under their EAP benefit. And the other suggestion is to be persistent. It took me nine months and several phone calls and emails to finally get approved.
Thanks, Valerie, for dropping in here. I had mentioned to readers that I was hoping you would be able to drop in to share your own ideas about this topic. Thank you thank you!
I’ve addressed specialties in the next post and referenced EAPA in the final post in this series. However, I appreciate you stressing that EAP panels and the possibility of clients choosing to remain with a therapist (after their EAP benefits run out).
And, I want to underscore that you . . . the ex-managed care insider:) . . . has indicated that therapists interested in contracting with managed care companies must follow up. Persistence matters!
I was just wondering the best way to make sure you note your specialty on your applications, some applications seem so general and also sometimes you just have a pre-application. Also if you can advise on how to get around the “you have to be licensed 2 years” line.
Sure, Jill! Applications may seem to be asking for general information but any time you have the ability to answer an open-ended question, you have the opportunity to emphasize a niche – and, the more specific, the better! Don’t give in to fears and “not-enough” thinking. An emphasis on being a generalist will only make your forgettable.
The requirement that you be licensed for X amount of years, is actually much more difficult to address if you don’t already meet this requirement. I have no idea if managed care companies even consider waiving this one but if they do, here are some of the things that might make them take a second look at you . . . .
If you are relocating from another state in which you had licensure OR if you are currently under clinical supervision and also engaged in consultation . . . . Those things might increase the likelihood. But, a smarter way to make early inroads into managed care would be good old-fashioned, off-line, face-to-face networking with managed-care insiders who are already working with the company that you want to work with. They could tell you if and under what circumstances expceptions are made.
Thanks, Jill, for extending this conversation with your probing questions . . . . It is information that a lot of our community is in need of!
Thanks Tamara. Those are very good pointers, I have just been working on a lot of these applications, and some of them I have already sent in, but I am glad to read these posts. I am glad to hear you say to show a niche, so many want to be generalists, but I think that if you do that you are missing out on finding work that you love and seeing the clients you enjoy working with. Even if it takes more time to build a practice it may be worth it. I am writing this as I am tempted to take anything that walks in the door that will pay my fee right now because there’s those burning bills to pay in the back of my head.
Jill, I see that you and Tanya both are chomping at the bit to get those clients in the door. In my experience, the tighter that niche, the faster the right clients will find you. I know it sounds . . . feels counter-intuitive but it works.
Having a niche is my biggest selling point. I only work with children ages 3-12. When parents or caregivers initially contact me it’s because they want someone who is specialized. That means they have confidence in me from the start.