Insurance credentialing hospital privilege

[nimat_do]

I want to go into private practice in Texas and I would like to get on insurance panel. I do not currently have hospital privilege and do not work at a hospital. My credentialing person says I need to either work at a hospital or get a letter from someone who does. Don't have that currently as options. Has anyone encountered it and is there any work around to it?

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[comp1]

I've never heard of this, but also never worked in Texas. Can you explain a bit of reasoning as to why they need this? Can you get someone from your residency (which I assume was affiliated with a hospital) to write something? What is this letter supposed to say?

 

[nimat_do]

My training is in NY, so they can't really help in that sense. But for example on the BCBS site
"Required to have hospital privileges at an in-network hospital for each network of participation, or May be permitted to submit a signed Hospital Coverage Letter".

 

[When is graduation again?]

I just did this actually for my CAQH profile. Where it asks for hospital admission process, I put I assess patients and voluntarily admit or ivc them to local hospital. BCBS accepted this. They're the only ones that required it. BCBS is the worst insurance to credential with because they make everything as long and complicated as possible and have hour long phone wait times.

 

[nimat_do]

I just did this actually for my CAQH profile. Where it asks for hospital admission process, I put I assess patients and voluntarily admit or ivc them to local hospital. BCBS accepted this. They're the only ones that required it. BCBS is the worst insurance to credential with because they make everything as long and complicated as possible and have hour long phone wait times.

Are you in TX? I plan on using that explanation

 

[allantois]

Your credentialing person is clueless; get another one

 

[Sushirolls]

Agreed. Your credentialling person is clueless.

Hence, why I recommend that people not use credentialling people.

I haven't run into this with BCBS.

I ran into it with another insurance company in my area, and simply opted to not get paneled with them, as they didn't budge on that requirement. I happily accepted those patients as cash pay.

Any of the others that want you put down who your back up is. Or how you admit. I wrote a snarky sentence like, "this is psychiatry, and the standard of care does not require hospital privileges, or back up, nor admit plans beyond referring a patient to an Emergency Department." Those insurance companies approved my application.

When Big Box shops were even doing that... no after hours call, no direct admits, just simply "go to ED" I've since declared what is observed.

 

[When is graduation again?]

I just did this actually for my CAQH profile. Where it asks for hospital admission process, I put I assess patients and voluntarily admit or ivc them to local hospital. BCBS accepted this. They're the only ones that required it. BCBS is the worst insurance to credential with because they make everything as long and complicated as possible and have hour long phone wait times.

I'm in NC. Those weren't the exact word I used btw, but the spirit of what I put. Make sure to highlight that you're using the standard of care and you shouldn't have any issues.