The decision to leave an insurance panel (or all of them) is often one that creates a bit of angst and uncertainty. We might question whether or not we are making the right decision, and we’ll certainly ask ourselves how doing so will ultimately impact our clients and our business.
Unfortunately, some insurance companies create a roadblock that impedes our ability to deliver services. We’ve all heard the horror stories of delayed reimbursement, denied claims, and low rates, haven’t we?
We are also acutely aware of the increasing rise in mental health distress and the multitude of barriers that impact whether or not clients seek or engage in therapy.
Ultimately, in order to continue to serve your clients and the community you work in, we all must make decisions that are tough but necessary.
As a pro-insurance practice owner, I too have had to make the decision that some insurance panels weren’t aligned with my business model or the way I wanted to serve clients. Here are a few things to consider before un-paneling.
1. Reasons for Terminating the Contract
I don’t mean this in a “how do you justify it?” way, but rather, what are you noticing and what experiences are influencing your decision?
For example, in my Facebook community, Mastering Insurance, we talk about how reimbursement rates are a barrier. We also discuss how to navigate the rate negotiation conversation with insurance. We use a data-driven process to rate negotiations, which requires that you know your numbers and that you’re willing to do a bit a research to gain a deeper understanding of the average cost of services in your area. We have a template in the FB community to help you draft a rate negotiation letter or email. Maureen Werrbach, LCPC also shares how you can use fee schedule increase request letters to earn more as a practice that accepts insurance in another blog post.
Start with your why and identify ways to address it. If you still come to the conclusion that un-paneling is the best option, then tips 2–4 are for you.
2. Know Your Numbers
How many clients are impacted if you un-panel? What percentage of clients seen have this insurance? What percentage of your revenue does that amount to?
We want to anticipate the possibility that at least 50% of your clients who are impacted might terminate services. We can prepare for the transition by offering options to those clients through things like sliding scales, seeing an intern, referrals to an in-network provider, starting a group to defray the costs, etc.
3. Notify Insurance and Your Clients
Review your contract to determine how much notice you need to give the insurance company. Most insurance companies tell you the process they require for this type of notification. Most often, this is done in writing and via mail. All of my contracts require that I give a 60–90 day notice. It’s important to note that the 60–90 clock, when you’re officially out of network, doesn’t start when you send in the notice to insurance but when they acknowledge receipt and processing. Keep a copy of the notification and follow up to ensure that it is received and processed in a timely manner.
Your contract also tells you how much notice you must give clients and how long you must remain in network after the notification period. Hence, you can’t charge those clients your OON rate during this time.
We notify clients in person at their next available session, and after they’ve had an opportunity to process it with their therapist or the practice administrator, we follow it up with a written document as is required by insurance.
4. New Clients
So, what happens if a new client calls and wants to use their insurance while you’re in the un-paneling stage?
This can get tricky. First, you’re still in network. If your status has been received and acknowledged, you can choose to not take any new clients with this insurance plan. Generally, you must let the insurance company know this. If this has been done, then new clients would need to voluntarily opt-out of using their insurance in order to be seen at your practice during this stage. You want to have an honest conversation about their options without being coercive.
5. Expect Hiccups
The unfortunate truth is that the un-paneling process can be lengthy and tedious. Have a follow up process in place. We set reminders in our project management system to remind us to call and check the status of our un-paneling. After you’re notified that you’re no longer in network, you might want to test a claim as soon as possible. It’s possible that the credentialing department will update that you’re out of network, but the claims department doesn’t fully update your profile and claims might pay at the INN rate.
Good luck on your practice-building journey. I hope this was helpful!
