The insurance paneling process can be challenging for mental health providers, so much so that some therapists may skip paneling altogether or only work with a few insurance companies. Deciding which companies to panel with can involve determining whether it fits your goals and needs, reviewing paneling requirements, and considering nationwide and statewide insurance providers. Each option has pros and cons, so becoming informed about the choices available to you can be vital as a practitioner.
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What Are Insurance Panels?
“Insurance panel” means a group of professionals aligned with an insurance company, allowing them to accept insurance for patients enrolled in those plans. Many insurance companies accept a certain number of professionals each year for their panels, and the process of applying to a panel can be competitive. For popular insurance panels, therapists who offer unique benefits to their clients may be more likely to be approved. For example, companies may look at the following factors:
- Whether you work an in-demand schedule outside of standard business hours
- Your hourly rates
- Whether you’re a credentialed specialist in any area of psychology
- Your continued education courses
- Whether you can offer crisis services or support for people with rarer diagnoses.
Therapists can work with multiple insurance panels and apply to both state and nationwide companies. The process often takes a few months, though it may take longer in some cases. For this reason, some therapists may want to look for the best panels for their practice before they begin the application process.
How To Determine Which Panels Are Best For Your Practice
Therapists may make a few considerations when determining which panels work best for their practice, including but not limited to the following:
Panel Size
Insurance companies offer various insurance credentialing slots for new therapists each year. Larger insurance companies may offer more spots but are often applied to at a higher rate. Small and local insurance companies may have less competition if you live in a rural or more isolated area where therapists are in high demand.
It can be useful to consider which insurance companies your prospective clients may be most likely to use, so that you will be able to serve more clients. For instance, some cities may have higher numbers of clients using government-sponsored plans like Medicaid, whereas others might have more clients with local coverage.
The Number Of Panels
Therapists often work with multiple insurance providers to provide the most coverage possible for as many clients as possible. The number of panels you want to join can depend on your goals, needs, specialty, and location, among other factors. If you choose to work with multiple insurance companies, you might consider whether you want to work with a few larger companies alongside a government insurance plan or if you want to work with a more extensive selection of state and local companies.
Reimbursement Rates
Each insurance provider determines its own reimbursement rates, regardless of the rates one might charge for clients out of pocket. Often, insurance companies pay therapists less than their regular rates, with government plans potentially paying even less. In these cases, part of the cost of the session goes to the insurance panel and the rest to the therapist.
Insurance companies may also have the right to reject a bill if they believe the services were not medically necessary or went outside the plan’s guidelines. In these cases, it can be essential for therapists to keep an eye on the unique filing guidelines for each panel they work with. Working with a few panels that offer higher reimbursement may help offset the lost wages from working with one that offers lower insurance payments.
Panel Requirements
Each panel has unique requirements for approval. Some may require counselors to work a certain number of hours or take on a certain number of clients. Others may prefer paneling with therapists offering unique services that are sparse in their area. When looking for a panel that works for your practice, consider how many clients you can take on, what hours you’re willing to work, and how you want to bill clients.
Popular Insurance Companies To Panel With As A Therapist
Although the “best” insurance panels for therapists can be subjective and may vary based on a therapist’s unique situation, goals, and location, below are a few popular insurance companies to consider:
Blue Cross Blue Shield
Blue Cross Blue Shield (BCBS) has different application requirements by state. For instance, Blue Cross Blue Shield of Illinois uses the Council for Affordable Quality Healthcare (CAQH) ProView application for its credentialing process, and it details the process on its website.
Blue Cross Blue Shield is made up of 34 independent and locally operated BCBS companies, and it prides itself on providing healthcare coverage for around 115 million members nationwide. Reimbursement rates can vary by location, specialty, and therapist education level.
Medicaid And Medicare
Medicaid and Medicare are government programs in the U.S. that offer services to low-income, disabled, and elderly individuals. These programs can offer healthcare coverage to individuals who may not be able to receive services otherwise. Some therapists choose to accept these plans, serving more marginalized groups or people who might be able to pay for their out-of-pocket or sliding-scale costs.
Some people may take limited government insurance clients because these plans may pay less to therapists. However, the Medicare insurance reimbursement rates can depend on the CPT code for the session and the location.
Cigna
Cigna serves millions of individuals in the U.S. and around the world. They offer behavioral health credentialing for therapists and other mental health providers. A few of their requirements include the following:
- A license to practice independently
- Professional liability insurance with minimum limits of $1 million in most states
- An application to panel with them
- A “screening application” for behavioral health clinics, if applying as a clinic
Cigna claims they can approve applications within 20 business days of the first application for those who have not paneled with them before.
UnitedHealthcare
UnitedHealthcare works with licensed mental health professionals to provide insurance coverage to clients nationwide. They state there are four steps to joining their network, including the following:
- Submitting an application with relevant information
- Verifying your experience and right to practice
- Reviewing and signing your participation agreement
- Setting up online tools, paperless billing, and training
For those who want only to provide telehealth services, the company requests that providers contact them directly.
State-Specific Insurance Companies
Each state has unique statewide insurance companies that can sometimes offer behavioral health services. For example, Mountain Health Co-Op offers coverage for Montana, Idaho, and Wyoming residents in the Northwest. Companies like these are often smaller and offer local benefits that larger companies might not achieve. Small companies may pay providers more, as their insurance rates may be higher.
How Does The Paneling Process Work?
The paneling process can vary per company but generally involves preparing documentation, applying to the panel, receiving a decision, and going through any appeals process. It may take longer for larger companies to approve an application, so some providers may first apply with companies with a shorter wait time while waiting to take insurance with more prominent companies.
After you are approved to accept insurance, ensure you read the documents sent to you by the insurance company to understand your reimbursement rates, billing codes, and billing requirements for insurance claims. You might also be required to print out or save forms unique to the insurance company, so keep these separate from other company forms. When you work with a client that has insurance with the companies you are paneled with, be sure to follow the company’s billing process closely. Some companies may offer paperless billing or an online portal that providers can use to submit claims quickly.
Takeaway
Accepting insurance can be challenging if you’re unsure who you want to work with and how to find the best insurance panels for your practice. Many different insurance companies in the U.S. reimburse behavioral health providers; you can consider some of the tips detailed above to help you determine which panels may be best for you. To further understand the requirements of getting paneled, contact the companies you are interested in to enquire about their application process and insurance billing.
