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.

 

[doctorsun]

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?

Having same problems. Own practice in TX, DPC didn't attract patients and had unexpected financial expense, forcing me to close clinic and transtion to home visits only and to traditional health insurance. Applied to health insurance companies. BSW wants you to use only their labs and services even though my EMR already programed to sync with a national lab service. Humana wants me to sign another physician with hospital privileges on their application -- dropped them. Cigna "we are not adding providers in your specialty / area." United healthcare denied credentialing because no hospital privileges. Told me to write a letter stating I will facilitate hospital admissions despite not having admission privileges, which I did. They reportedly accepted letter and resumed credentialing process but a week later, checked status, still declined, UHC rep knows nothing about letter I wrote and refused to accept another letter because I have to include another physician with privileges in the letter.

Not to mention liability insurance companies and their "sorry but you are not our underwriting's taste" while they refuse to insure you for doing home visits only just to gather a small patient panel before investing in physical clinic -- despite you having a clean claims history.

So unless you join an established physician group, not easy to be a PCP in my experience.

 

[Sushirolls]

I recently had 2 insurance companies do their 're accreditation' with me and requested a what's up for hospital privileges. Reminding them not the norm, not the standard and go to ED is what happens. They signed off on it.