How to Exit an Insurance Panel
If you are currently credentialed with an insurance company and you have decided that you would no longer like to work with this insurance company, there are a few different ways that you can go about exiting an insurance panel. There are also many reasons that you may be considering exiting an insurance panel, which may influence which route is the best for you. In today’s post, we are diving into each of the methods that you can exit an insurance panel and what circumstances make the most sense for each method.
Before you move forward with leaving any insurance panels, we recommend checking out our other blog post on 3 Ways to Know When You Should Leave an Insurance Panel. If the reason that you are wanting to leave an insurance panel is because you are having repeated issues with claim processing, we encourage you to consider signing up for billing services through Practice Solutions before making your decision. With our expertise, we have been able to help hundreds of clinicians just like you to collect thousands of dollars from insurance providers. If you are considering leaving a panel for other reasons, read on.
Let Your Contract Lapse
When you credential with an insurance company, the contract often has an expiration date on it. The average length of a contract with an insurance company is 3 years, however it varies from insurance company to insurance company. If you want to remain credentialed with an insurance company you will need to complete a contract renewal process, which is much less involved than the original credentialing process. However if you would no longer like to be paneled with that insurance company, you can let your contract lapse. This is the most passive method of exiting an insurance panel.
There is no penalty to you for letting your contract expire, or for staying credentialed with the insurance company during a period where you have no current patients with that insurance. This can be a good method if you have no patients with this insurance company at the moment, but you would be open to accepting patients with this insurance. You would remain on the insurance company’s provider list, and patients could find you through their website or portal.
We recommend looking into the exact date that your contract would expire with the insurance company and noting it in your calendar. A few weeks prior to the expiration, you can re-evaluate whether you still want to let the contract expire, or if you would like to renew your contract. Keep an eye out for any correspondence from this insurance regarding contract renewal processes and keep it on hand, or reach out to the insurance company to know what to expect ahead of time. If you end up deciding that you are okay to cut ties with this insurance company, you shouldn’t need to do any other steps aside from waiting until the contract expires!
Temporarily Stop Accepting New Patients
If you are taking an extended holiday or sabbatical from your practice, taking time off for maternity leave, or a leave of absence for health reasons with an intention to return to Private Practice, you may want to consider keeping your contract active but working with the insurance company to let them know that you are not accepting new patients at this time. If you intend to resume submitting claims to the insurance company in question, or you think that you may acquire more clients with this insurance in the future then you may want to keep the contract open, just in case.
This way you do not have to go through the credentialing process when you return to work, but you will not have patients seeking care in your absence. Most insurance companies have provider directories where they can note whether or not a provider is accepting new patients. By speaking with your provider representative, you can determine what the best course of action is for a temporary break.
Many insurance companies have an option through their provider portal to select “not accepting clients”. This is an option that should be reviewed when deciding to stop taking clients with an insurance company. Additionally, you should review the ethical standards around refusing clients to ensure that you are operating with the highest ethical standards as possible. Insurance companies know that you cannot take clients indefinitely and they have created ways to make sure that you communicate that effectively.
Reach Out to Provider Services or Provider Relations to End the Contract
If you have fully committed to your decision of leaving an insurance panel, you will want to reach out to the insurance company’s provider services or provider relations department. Explain that you are currently credentialed and that you would like to exit your contract, and they should be able to direct you to the right person or next steps.
Removing yourself from a panel that you are absolutely certain you no longer want to work with is important because it opens up a space for another provider to credential with this insurance company. The sooner that you exit, the sooner someone else can enter and serve more patients!
Making the Right Decisions for Your Practice
Leaving an insurance panel can be a smart business decision, but it is important to consider all of your options and make the choice that best fits your practice. Whether that be leaving an insurance panel, suspending new patients with that insurance, or hiring a biller to help you resolve issues that you are having with that insurance company. This article is meant to help you in making informed decisions about how to proceed, but ultimately you know your practice the best and the choice is up to you!