Whether you are a healthcare provider in private practice, or working for a larger medical center, there are a number of reasons that getting on insurance panels is important to your professional success.
Need help getting on Insurance Panels? Give us a call at 1-855-4-THRIVE.
1) Getting on Panels Gives you Leverage
Sometimes mental health counselors who work for hospitals or large therapy practices think that getting on insurance panels isn't important, or that they are already listed with insurance companies--this isn't true! If you are working for a large practice or company, you are likely working under their contract with insurance companies. Therefore, you--personally--are not paneled. This means that if you were to leave your job, you would find yourself unable to accept new clients' insurance, even if you've been billing insurance for years.
Being independently credentialed means that you are protected if you ever decide to leave your current job, and even means that you have some leverage (a "bargaining chip") with your employer when you discuss compensation increases.
2) HMOs Greatly Outnumber PPOs
Persons with PPO plans can see counselors, psychologist, and psychiatrists that are no part of their network (that is, un-credentialed licensed professionals), under some circumstances, and usually for additional cost to the patient / client.
However, the PPO plans have quickly become a plan of the past as HMO plans greatly outnumber them. Moreover, persons with PPO plans now face significant penalties and fees for choosing a provider out-of-network, such as higher deductibles and only a fractional split of mental health care fees. The bottom line--if clients are going to use their insurance, they will want (if not need) you to be in network and paneled with their insurance company.
3) Universal Healthcare and Mental Health Parity means that Everyone can see a Therapist
Two huge changes in healthcare make it crucial for all mental health counselors / therapists to be credentialed on at least some insurance plans. The first is the universal healthcare bill, which will make it so that persons in the USA--universally--will have health care coverage (and will want to use it!). The second change is the Mental Health Parity laws, which states that mental health care is not an optional part of health care, but is obligatorily covered with other major medical coverage. If you are unable to accept insurance, it is going to be a hard sell to acquire clients with this coverage.
4) Panels Will Close
Saying "get on panels now or else" sounds dramatic, but the truth is that many panels are already closing, or closed. In Boston, many of the major players: Harvard-Pilgrim, United Behavioral Health, BCBS HMO, and Tufts are not accepting new providers. What this means is that for new counselors entering the field, they are literally unable to see any clients from those huge pools of clients. And it means that the counselors on the panels have few problems filling their schedules.
You might wonder "Why would insurance companies limit the number of providers on their panels?" That's a good question--the companies often state that paneling mental health professionals costs them money administratively, and once they have enough providers they would be wasting money if they brought on more. However, others say that the more the insurance companies limit the number of providers who are on their panels, the less likely a patient will be able to use their insurance benefits. Whatever the reason, the ugly truth is that if you want to be on insurance panels, you're wise to start sooner, not later.
MentalHealthCredentialing.com helps clinicians get listed on insurance panels in their area of practice. Call us to get started, or for more information at 1-855-4-THRIVE (1-855-484-7483).