insurance panels

[bmedclinic]

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So, I'm joining a group private practice where my plan is to do mostly health psych and maybe in the future spend some days in integrated primary care through this group.

Anyways, I'm taking the next 2-3 months to transition from my current position to private practice. Though I'm very excited and encouraged, I'm also a little overwhelmed. Today I've been working on applications for insurance companies I've never heard of, and at least one of them has some rates (90834/90838) I'm not too fond of, in theory.

Wondering who all has been through this, and any advice? Can I be on that panel and then drop them when my caseload gets a little more secure with better paying ($20 diff per 45 min) insurance companies?

 

[Therapist4Chnge]

1. Know your area. Are there many providers, or are you only one of a few? Who is the biggest employer in your town/city? What plan(s) do they offer?
2. Know the going rate. I consider Medicare to be the floor for reimbursement rates.
3. Ask around. Some insurance companies are much harder to deal with than others.
4. Consider limiting your panels up front bc sonetimes it can be a hassle to "drop" a panel.
5. Consider 1-off contracts. Some companies who employ ppl out of their region may not contract with a network in your state. They know they will be paying out of network, so they'll offer a single patient contract. ALWAYS READ THEM. I typically stick to my cash rates, ensure it is only applicable for that one patient, and avoid any "offer" to join/sign for future work. At least for specialists, they need you a lot more than you need them, so being able to negotiate rates each time allows you to account for the hassle.

 

[bmedclinic]

Thanks so much for #2, especially. I just went and looked at medicare reimbursement. Good rule of thumb!

I live in a medium sized metro area and am joining a well established, well thought of practice. so I have some guidance from those guys as well.

 

[bmedclinic]

also just talked to practice manager on phone, she basically told me 4 to focus on, and to not worry about the one in question due to reimbursement rates.

Nevertheless, this is something worth discussing more on here as many of us probably deal with it and talk little about it.

 

[DrMikeP]

Some insurance panels actually pay better out of network than in. One in particular allows $45 in network with a $40 copay, so they pay you $5, but will pay 60-90% OON.

Many times I've seen ins companies list 5 different rate tiers ($45 to $175/hr) and the best be in the front and the worse hidden in the middle. You may never see the $175, but get 10 calls from the $45 group/wk. So look closely when you consider the agreements.

Check out availity.com (It's free and you can look up pt ins benefits quickly and get fast access id #'s to get you straight through to customer service to verify/discuss benefits.)

Also, many insurance companies require a certain level of malpractice insurance. One wanted a $3M/$5M, which is ridiculous.

 

[Ollie123]

One in particular allows $45 in network with a $40 copay, so they pay you $5.

My goodness. Even medicaid pays way better than that here.

 

[DrMikeP]

My goodness. Even medicaid pays way better than that here.

Yup... I owned an ins billing company and was amazed at some of the horrible reimbursement rates some ins companies paid. I also discovered that not every psychologist is offered the same rate (some a difference of $50/hr) and that you can negotiate significantly.

I dropped commercial ins and was only on medicare, but would bill OON.

 

[Therapist4Chnge]

Clinicians lose 100% of the $'s they don't pursue (whether it be in rate negotiations or collections).

 

[bmedclinic]

Check out availity.com (It's free and you can look up pt ins benefits quickly and get fast access id #'s to get you straight through to customer service to verify/discuss benefits.)

Also, many insurance companies require a certain level of malpractice insurance. One wanted a $3M/$5M, which is ridiculous.

I didnt know about using availity like that. I already have some type of an account with them from a past endeavor. Good to know I can use availity that way.

Also I'm currently increasing my malpractice to 2.1/4.2 for the same reason- and I bet the same insurance company, too. Only cost me $30 this year to increase it. I'm sure it'll add up in time, but I saw those rates, so I'm somewhat prepared for them.

 

[bmedclinic]

1. Know your area. Are there many providers, or are you only one of a few? Who is the biggest employer in your town/city? What plan(s) do they offer?
2. Know the going rate. I consider Medicare to be the floor for reimbursement rates.
3. Ask around. Some insurance companies are much harder to deal with than others.
4. Consider limiting your panels up front bc sonetimes it can be a hassle to "drop" a panel.
5. Consider 1-off contracts. Some companies who employ ppl out of their region may not contract with a network in your state. They know they will be paying out of network, so they'll offer a single patient contract. ALWAYS READ THEM. I typically stick to my cash rates, ensure it is only applicable for that one patient, and avoid any "offer" to join/sign for future work. At least for specialists, they need you a lot more than you need them, so being able to negotiate rates each time allows you to account for the hassle.

So since I'm at the beginning of this process, were I to follow your points above, I'd stick with medicare and Anthem. The rates I see for everyone else appear to be significantly lower. Best to stay as an out of network provider for everyone else? I'm open to thoughts from those of you who are in private practice.

 

[DrMikeP]

So since I'm at the beginning of this process, were I to follow your points above, I'd stick with medicare and Anthem. The rates I see for everyone else appear to be significantly lower. Best to stay as an out of network provider for everyone else? I'm open to thoughts from those of you who are in private practice.

Blue Cross is good in some states and horrible in others. In some markets they are closed to adding new providers. Medicare is worth it because it gets really really complicated if you see a medicare pt OON.