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Back to EpisodesAccepting Insurance and Third-Party Payors In Your Private Practice | TPOT 204
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In this episode, I talk about some of the myths and misperceptions people have about being on insurance panels. I delve into this topic and let you know what I've learned about it from my insurance-based practice. First, I speak about the stigma around accepting insurance in private practice. If you accept insurance, you are just as valid and can be just as successful as private practice owners who are cash-based. Tune in as talk about the pros and cons of insurance panels, why I chose to be insurance-based, and where to start when you decide to accept insurance.
The Stigma Around Accepting Insurance In Private PracticeMany people are curious about accepting insurance and if they should or not. There is no correct answer. If you start to delve into your mindset and think about it all, it might just be something that you should consider doing. When you look at all that is out there, there are so many great resources around building a private practice. It seems like most people are encouraging cash-pay. There seems to be a little bit of a stigma against having an insurance-based practice. Many people say that you don't want to be controlled by insurance companies. If therapists don't have a cash-based practice, they're second-class citizens for being an insurance-based practice. I don't agree with that at all! In fact, my success comes from being insurance-based.
The Pros and Cons of Being An Insurance-Based PracticeThere are a lot of pros and cons to being on insurance panels. Certainly, one of the cons of being insurance-based is that you've got to have more systems and processes in place. You've got to do more work on the front end to get prepared for insurance. You need specific systems when you start accepting third-party payors and being reimbursed by insurance companies for your services. The biggest con is that there is some work on the front end of being insurance-based.
The pros for being insurance-based are that you've got a built-in referral source by being on insurance panels. I would say at least half the people that we find are from their insurance. In other words, they checked with their insurance provider first to see who would accept their insurance in the area. When making an appointment with us, people ask, how much does it cost? Plus, they ask if we accept insurance. That's why I wanted to be an insurance-based practice. People depend on their insurance, and I want to help those people.
Ready To Accept Insurance? What To Do FirstWhere do you start? Research your area to find out which are which insurance panels are the most prevalent. In my area, most people have Blue Cross Blue Shield health insurance. Another thing to research is looking at significant employers in the area. Then, check which insurance those companies use. Next, use that data to decide which insurance companies you want to be paneled with. Another thing to note is that when an insurance company offers you a contract, that's negotiable! Make sure to negotiate what rate you will accept.
Systems and Processes Around Filing Insurance ClaimsFigure out your systems and your processes around filing insurance claims. If you're on insurance panels, you need a traditional way to send claims off. The best way I know to do that is through an electronic health record system. TherapyNotes helps my practice with this. It's a few clicks of a button to get your insurance claims sent to the insurance companies to be reimbursed. For the most part, insurance companies have a pretty quick turnaround for electronic health claim submissions. Within a week of sending off the claim, we are getting paid. There's a myth that you have to wait a long time to get paid from insurance companies – that's not true! So, make sure you have a way to submit claims and make it as automated as possible.
Cash-Based and Insurance-Based Private PracticesIf you're not ready to be entirely reliant on insurance, there's a hybrid option