Switching from self-pay to insurance

Self-Pay to In-Network: How To Accept Insurance as a Therapist

As a self-pay practice, you may already have a steady stream of patients who come through your door. But you know there’s potential to increase that patient flow — potential to help more people and grow your business. 

Accessing that patient population, however, means learning how to accept insurance as a therapist — switching from self-pay to in-network. 

This transition can feel overwhelming, with forms to fill out and time spent checking on applications. Nevertheless, it can be a critical step in growing your business and supporting more of your community. And breaking down the steps of how to accept insurance as a therapist can help make the process less daunting.

Let’s dive in.

The Benefits of Accepting Insurance in Private Practice

If you’re on the fence about becoming in-network with an insurer, consider these pros:

  • Insurance companies may list you in their provider directory, giving you more visibility and promotion within your potential patient community.  
  • Your services may be available to a bigger group of clients, as many patients who can’t afford self-pay can use insurance to seek treatment. Even those patients who can afford self-pay would likely rather use insurance.

The Downside: Why Don’t Therapists Take Insurance?

You may be well aware of some of the cons of taking insurance. But let’s get them out in the open so you can weigh them against the pros. 

  • You can sometimes make more money per session if a patient is self-pay. Insurance companies typically reimburse therapists at a much lower rate than what they charge per hour — and those rates don’t often increase.
  • The healthcare revenue cycle management (RCM) process can be resource-heavy. Coding and filing claims and waiting on reimbursements take a lot of time and energy, especially for private practices that may not have the resources of a billing department.

How to Accept Insurance as a Therapist

If you’ve decided that accepting insurance is the path for your practice, the process doesn’t happen overnight. And remember, you can always take a combination approach where you offer self-pay but also accept insurance from a couple of payers. 

Here’s a high-level overview of what to expect when you start the process of accepting insurance. This process is also known as joining an insurance panel or getting credentialed.  

Select Your Payers

It’s important you don’t just sign up with any insurance panel. Do the research and find out which payer panels best fit you and your practice. Consider these points:

  • Open slots – Is the payer open to new providers joining? You don’t want to start the paneling process only to find no available slots with that insurer. If you find most payers in your area are closed to new providers, consider reaching out to the payer and explaining what you can offer in your community that’s different from the providers already on the panel.
  • Market share – A payer with a larger market share could mean more potential patients. 
  • Contracted rate – Avoid insurers that pay below the Medicaid rate.
  • Peer opinion – Ask other clinicians in your community what they think of different payer panels. Find out how easy or difficult it is to work with specific insurers. 

Get Details in Order

Once you decide which insurance panels you want to join, get some critical details in order before you start applications. These items include:

  • Professional liability insurance
  • Practice location
  • National provider identifier (NPI) numbers for you (type 1) and your business (type 2)
  • Licensing for the state where you’ll provide services
  • A business entity (LLC, S-corp, etc.) and tax ID (if you’re a solo clinician, get a federal tax ID, so you don’t need to use your social security number)

You’ll also want to create a Council for Affordable Quality Healthcare (CAQH) login and make sure your profile is up-to-date (note that the insurance panel may need to invite you to CAQH first).

Apply to Payers

When your practice details are in order, reach out to the payers you’ve selected and ask about the credentialing process and applications. Remember that the credentialing process can take time — sometimes, you may wait 90-120 days before an insurance panel accepts your application. 

The applications can also be time-consuming, so set aside a few hours for each. Depending on the requirements, you may need as much as 10 hours for an application.  

There will also likely be a portion of the application you complete with CAQH. As we noted earlier, you may need to start the application process with an insurer and wait for them to invite you to CAQH. Then, you must complete the CAQH portion of the application before your insurance panel application process is complete.

Once you submit your applications, keep an eye out for any follow-up communications or questions from the insurer and answer them promptly. Don’t forget to document all these communications. 

You will also need to re-attest the information in your CAQH profile every 90 days to avoid problems with any applications or existing credentials you may have.

Submit Claims

After the insurance panel(s) accept your applications, you can submit claims for the care you provide. You’ll want to review all the payer billing guidelines to ensure your practice avoids hiccups in the reimbursement process. 

Here’s an overview of the claims and revenue cycle process and the steps needed to get reimbursed from insurers. 

Many private practices outsource their revenue cycle work, especially if the billing process takes time away from patient care. If you’re considering this option, it’s critical that the RCM service integrates seamlessly with your EHR.

Accepting Insurance in Private Practice: Great Potential, But a Process

Getting on an insurance panel does create the potential for growth and helping more individuals. But there’s no denying the long process it takes to get credentialed, not to mention the administrative work that comes with filing claims. Ultimately, you’ll need to decide what’s best for you, your business and your patients.

WATCH: Revenue Cycle Tips for Staying Independent

Many physicians are leaving private practice due to rising costs, lower reimbursement rates and staffing shortages. But staying independent is possible with a healthy revenue cycle.

Learn how to run a successful private practice with tips from this 20-minute webinar session.

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5 Must-Know Metrics To Build A Thriving Medical Practice

With this free guide, you’ll learn the key metrics that inform your practice’s financial performance and how best to optimize them to support practice growth.

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