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!