• Practice Solutions

When to Consider Getting Out-Of-Network


The dominant narrative that we hear from providers is that they must be in-network in order to survive as a practice. Consequently, we see therapists and psychologists panel with as many insurance companies as possible.

The problem, therein, is that the practice becomes inundated with paperwork, aging claims, rising write-offs, and ultimately the inability to grow or scale or maintain the practice. This becomes a barrier to the practice owner and therapists enjoying the field they are passionate about.

One way to regain the freedom of private practice is to limit how many practices you are in-network with, but how do determine when getting out-of-network is valuable?

1. You Are Losing More Than You Are Winning

As you consider getting out-of-network, you will want to look at the data of your practice. Let's say you charge $165.00 per 60-minute session, but Insurance Company "Y" pays a maximum of $65.00 per 60-minute session. That means you are losing a $100.00 per session!

If you are out-of-network you could charge the patient $165.00 up front and then bill the insurance or give the patient a superbill so they can take care of the billing. This means that you are now regaining 100% of the billed charges instead of losing 40-60% of the billed charges.

2. You Are Constantly Stressed By An Insurance Company

A thorn in the side of therapists is dealing with the bureaucracy of insurance companies. One truth of the insurance industry is that some insurance companies are better to deal with than others.

If you find yourself constantly stressed by how many errant denials you receive, chronic paperwork, chronic delays in claim processing, chronic delays in provider credentialing, incorrect reimbursements, etc. You may want to consider leaving the panel.

3. The Patients Aren't Ideal To Your Specialty

If you are in-network with certain insurance companies you will inevitably provide services to certain demographics. Sometimes, those types of patients don't line up with what you want to focus on professionally, or you haven't had any specialized training to meet the needs of that group.

If you find yourself in this situation, it would be advisable to reconsider being in-network.

Conclusion

One fear with getting off a panel is the sudden exodus of a patient caseload. Here are a couple of thoughts regarding this fear: 1) if a patient finds the services valuable they will stick around, 2) getting out of network doesn't mean your patients will have to pay exponentially more, 3) if you have patients stick around they will likely make up for the financial loss.

Don't think that the only path to success is getting paneled with every insurance company. You have options and in some cases, these options will lead to less stress, more reimbursement, and a more fulfilling clinical experience.


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