Navigating Insurance Panels For Therapists: How To Get Approved By Insurance Companies And Start Taking Insurance
Getting paneled with insurance companies usually requires time, commitment, and organization. Many therapists avoid the process of accepting insurance out of concerns about making a mistake in the paneling application or not even knowing where to begin. However, there are steps you can take to ensure you submit the correct paperwork and reduce the chances of mistakes.
Step one: Gathering your paperwork for insurance panels for therapists
Required documents to apply for many insurance panels for therapists
- An up-to-date license in the state you are practicing in
- Your tax ID number, employer identification number or EIN (optional for self-employed providers), and national provider identifier (NPI) number
- Your practice address
- Proof of liability insurance if you rent an office or space
- Any further education credits or advanced training certificates
- Your resume
- Your graduate school transcript
- A letter of intent
- Professional references
- A taxonomy code if you plan to bill with Medicaid or Medicare
How to create a letter of intent and resume
Insurance companies will want to see your professional resume when you apply. Keep the resume around one to two pages long, with your contact information and license number at the top. Focus on what makes you unique; you can add your relevant education, special courses, past positions in the field, and skills.
On your resume, mention if you speak multiple languages, live in a rural community, have certification in a particular specialty, or offer crisis management services. Insurance companies may look for providers that offer unique services that clients struggle to find in certain areas. There may also be more spots on the panel if you live in a rural area.
In your letter of intent, let the insurance company know you’re interested in paneling with them. Tell them how you can benefit their company, which types of therapy you offer, and any specialties or further education credits you possess. Try to keep the letter upbeat, professional, and compassionate. Ensure you edit the letter for grammar and spelling, and try to keep it around one page in length.
Step two: Searching for insurance companies
Before sending your applications in, outline a list of insurance companies you’d like to work with. You can determine the most popular options in your state by checking other therapists’ websites to see which companies they are paneled with. Medicaid, Medicare, Cigna, Blue Cross, and Blue Shield are standard insurance options; each has its own application.
Organize your lists of insurance companies to choose which insurance panel you’d like to work with
Once you’ve found panels in your area, create a list or a spreadsheet to track them. Do an online search to find their provider panel application page and note the link or print the application to mail it to the company.
It may also be advantageous to write down the mailing address for each company. Ensure you’ve noted the application mailing address, not the company’s main residential address.
Step three: Submitting your application to the insurance panel
Once you have the application forms available for each panel you hope to apply to, print out the number of applications congruent with the number of companies you’re interested in. It may be beneficial to paperclip each stack of paperwork and look through each before filling out the application to ensure you’re not missing any forms.
Put each application in an envelope and mail it to the insurance provider’s application address. Take photos of each envelope sent and mark down the date it was sent for your records to keep track of the progress. You may also be able to get a tracking number from your post office if you mail the applications with a postal worker’s assistance.
After a week, you can call the insurance company to ensure they have received your application. Track this call and ask the agent the expected time until you receive a response from the company.
Note that this process of becoming an in-network provider may take a few weeks to several months. You may receive a faster response if you filled out your paperwork correctly, didn’t miss any forms, and have unique qualifications.
Step four: Applying for CAQH - Mental health credentialing
The Council for Affordable Quality Healthcare (CAQH) is an organization that connects insurance providers with medical providers like doctors, dentists, and therapists.
Mental health credentialing
This is another avenue for becoming credentialed with healthcare organizations. It helps companies ensure that the providers registered through the portal are licensed and have the credentials to offer insurance to clients.
You may be required to update this registration every three months if any changes are made to your identification numbers, office location, or licensing. Professionals must re-attest to ensure the data is up-to-date.
Step five: Addressing approval or rejection from an insurance panel
Rejections from insurance panels are standard. If you are rejected due to a full panel, there may be no spots for new therapists at this time. You can reapply or appeal your rejection to be reconsidered. However, panels may take several months to approve new providers. Consider reapplying every few months. If you believe you were rejected due to a lack of information, revise your resume and letter of intent. Including professional references and certificates from past career-relevant courses may be beneficial if you didn’t include them in your first application.
In addition, calling the insurance company to talk to the application department can help you discuss your case if you believe there was a mistake. Calling can warrant a faster response than sending a letter or waiting for a response in the mail.
How to get paneled with insurance providers
Many panels are looking for therapists that offer “above average” services. Adding additional languages, cultural education, trauma-informed education, or unique skills may benefit your case. In addition, insurance providers might seek those with hours outside a standard business schedule or those with multiple long-term clients.
If approved, ensure you read through the insurance contract from top to bottom before signing. Understanding the terms of your agreement before you start offering sessions can ensure you do not make errors in filing for payment.
Step six: Accepting insurance - Learning more about billing, coverage, and reimbursement from insurance companies
Once you can accept insurance, talk to your existing clients interested in billing their insurance plan. You can also advertise your new insurance options on your website or online biography page. Once you have an agreement in place with a client, use the paperwork provided by the insurance panel to bill for services. The insurance company may have sent you a billing guide and information about which services they will cover and how much you can charge.
On the billing form, you can be asked for a current procedural terminology code (CPT), which is a code used for billing based on the length of time for sessions or the type of sessions. For example, there are codes for 30-minute sessions, one-hour sessions, and testing services. You may also be required to add a diagnostic code from the DSM-5 for insurance to cover services.
Process of reimbursement
Once you have completed the claim, you will have a deadline through your insurance provider to file the claim. Some therapists hire billing specialists or bookkeepers to keep track of these records. It can be beneficial to file all your insurance claims within the shortest possible time frame so that you don’t miss any.
After you have filed the claim, the insurance company may reimburse you for services within 30 days or the timeline outlined in your contract. Ensure you have filled out the forms correctly, or there may be delays in your payment. This process can involve verifying whether your insurance company requires a diagnosis to bill for services.
Some clients may also be required to pay co-pays. Discuss your client’s insurance policy with them before treatment. If you’re not financially savvy and require support in the reimbursement process, you can contact a financial advisor for your practice.
Resources to aid in the process
Taking insurance can be challenging, but you’re not alone in the process, and there are various tools available to you, including the following:
- Insurance billing software: Many software companies offer therapist billing software that involves electronic claim filing, documentation, receipts, and pre-made templates to streamline the billing process.
- Note-taking software: Having organized notes can help providers keep all of their clients’ financial information safe and in one location.
- Policy creation tools: Therapists may be tasked with creating policies on billing, such as late fee policies, cancelation fees, and insurance guides for clients. Many tools and companies provide these templates for therapists to reduce the time it can take to create them.
- Electronic health record (EHR) software: An EHR program can help therapists keep client medical history in one location and often involves areas to take notes on referrals, releases, demographics, and session progress. It is an electronic version of a client chart, often used by medical professionals.
Takeaway
If you’re interested in working for a company where you do not have to bill for clients’ insurance, you can consider applying to become a therapist through a platform like BetterHelp, which allows providers to work from home.
How to get paneled for insurance as a therapist?
You can get paneled for insurance as a therapist by doing the following steps:
- Complete the paperwork.
- Search for insurance companies you want to get credentialed with.
- Submit your application.
- Apply for CAQH.
- Address approval or rejection from insurance companies.
- Accept insurance.
What does it mean for a therapist to be paneled?
For a therapist to be “paneled” means that the therapist agreed to become an in-network provider for a health insurance company. Insurance providers and companies typically establish panels of healthcare providers like therapists and doctors to provide mental health services to their insured members. Once paneled, the therapist can accept insurance payments from potential clients.
How long does it take to get paneled with insurance?
Depending on the process and the health insurance company, joining insurance panels to become an in-network provider may take several months. However, some health insurance panels may accept or reject applications and requests quickly. Mental health professionals must know the timeline, application process, and the documents required from the insurance company's website to ensure faster processing. For example, one must gather and submit complete documents, such as one's practice address, resume, proof of malpractice insurance, licensure information, and credentialing paperwork.
Once approved, professionals must review the contract before signing it in order to understand documentation requirements, claim submission and appeals processes, fee schedules, and current procedural terminology codes (CPT). Exploring the provider portal is essential to learn more about the client's policies, insurance claims, and resources. It is also good to gather and list the phone numbers of various company departments so you have them readily available when needed.
What is the difference between paneling and credentialing?
Credentialing involves verifying a provider's qualifications, such as licensure, education, certification, and training. Meanwhile, paneling or joining an insurance panel means becoming an “in-network” provider for an insurance company. Getting one’s practice listed on a panel may provide benefits. It may give therapists a wider reach, resulting in more clients with lesser marketing costs in their geographic area.
How long does it take to get credentialed with insurance companies as a therapist?
As a therapist or mental health care professional, getting credentialed with insurance companies may take 3-5 months. The duration depends on the health insurance company and completion of your credentialing requirements. Each company has a unique process of operating its own panel, so it's essential to ensure your documents are complete to avoid any delays in your application process. Professionals may research the step-by-step guide for getting credentialed in their state.
Why do most therapists not take insurance?
Therapists' reasons for taking or not taking insurance vary widely, depending on the practitioner. Therapists may choose not to accept insurance because of the low reimbursement rates based on their fee schedules and the overhead costs. Some in-network professionals may take a particular insurance plan if they’re content with the reimbursement rates, while others demand higher rates to provide services. On the other hand, some therapists may choose self-pay clients for faster payments and greater freedom in terms of therapeutic approaches and session lengths. Therapists who avoid taking insurance due to low reimbursement rates may opt for the traditional self-pay therapy model for their practice, choosing self-pay clients for greater control over fees and payments of their healthcare coverage.
Another potential benefit of accepting self-pay clients is that you may have more time to focus on your clients. You also won’t need to worry about the possible hassles of dealing with some insurance companies, including prior authorization requirements and non-covered services. Doing self-pay eliminates the time costs related to billing and appealing denials. It depends on the therapist as to which method will be more beneficial for them.
Thanks for the feedback!
- Previous Article
- Next Article
- Six Tips To Avoid Burnout As A Mental Health Therapist
- Addiction Treatment That Can Lead To The Best Recovery Rates
- Therapist Practice Management Software: A Vital Tool For Mental Health Therapists
- Therapist Tools And Software For Better Mental Health Practice Management
- Taking Insurance In Your Practice: The Pros And Cons Of Accepting Insurance