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As an individual healthcare provider, private practice, or a healthcare facility with many employed providers, it’s crucial to understand how insurance panels work if you want to treat more patients and earn higher revenue for your treatment. But navigating the world of healthcare policy and insurance claims is often difficult and time-consuming.
This quick guide will break down in basic terms what insurance panels are, the benefits of joining them, and how to make the process simpler.
Insurance Panel Basics
An insurance panel is a group of providers who work with an insurance company to provide patient care services specifically to clients who are enrolled with that insurance company. Every insurance company operates its own panel. Clients of each insurance company are entitled to seek treatments covered under their plan from providers who work on that company’s panel. See our blog post on provider enrollment for more information on this topic.
Whether you are a licensed psychologist, health practitioner or psychiatrist, to be able to treat patients who have health insurance, you will need to ensure that you or the providers in your facility work on one or more insurance panels.
However, there’s more to joining an insurance panel than deciding to do so.
If you want to be part of a certain insurance company’s panel—and get reimbursed for the patient care services that you provide to people who carry that health insurance coverage—you first need to be credentialed.
Insurance companies determine whether or not to admit providers to their panel during the provider credentialing process. This credentialing application process can take months to complete, as you have to fill out an assortment of paperwork and provide plenty of documentation, including:
- Copies of your medical school diploma or other licensing
- Training certificates
- Controlled substance certificates
- Current CV with detailed professional history and no gaps
- Hospital and facility affiliations
- Delineation of privileges form
- Record of any malpractice claims and subsequent disciplinary actions
- Certificate of Professional Liability Insurance Coverage
- Letters of recommendation from fellow providers who have observed you delivering patient care services within the past year
- Current immunization records
- Citizenship information, driver’s license, Federal Tax ID number, and other personal information
Joining an Insurance Panel: Pros and Cons
As you can see from the staggering amount of paperwork involved in the provider credentialing process, one of the major downsides of joining an insurance panel is that it takes a long time. Also, because each insurance company operates its own insurance panel, you’ll have to go through the credentialing process with each of them if you want to join multiple insurance panels.
Most providers want to join multiple insurance panels so they can see a wider range of patients.
That being said, one of the best benefits of joining an insurance panel is that you’re less likely to lose out on new clients.
For example: Consider a new client who walks into your office hoping to meet with a healthcare provider. In their preliminary consultation, they find out that you don’t accept their insurance. You then lose out on a new client and potential profit. If you had been a member of their insurance company’s panel, you would have been able to accommodate them.
Here are a few more common pros and cons that providers have to weigh when they’re thinking about joining an insurance panel:
- Pro: More referrals – Providers typically benefit from being listed as a “preferred provider” on an insurance company’s website after joining their panel. Patients frequently start their search for healthcare providers on their insurance company’s website. This leads to higher referral rates for you, and removes some of the pressure to constantly be marketing your practice.
- Con: Delays in payment – When you see patients who carry insurance, your payment comes partially from the patient, but also partially as a reimbursement at a later date from the patient’s insurance company. Joining an insurance panel will likely lead to a higher volume of patients, but you won’t receive instant payments in cash from them.
- Pro: Building confidence with patients – Although it is possible to operate a high-quality facility without going through the insurance panel process, some patients may not see it that way. Many prefer to only seek the services of providers who have been credentialed by their insurance companies, and not just because services will be covered. Providers credentialed by insurance companies are often seen as a more legitimate option.
- Con: More regulation – Once you become a member of an insurance panel, you lose certain freedoms that you may have had as a fully independent provider. For example, you will no longer be able to choose your own rates for patient care services. The insurance company sets guidelines for these rates that you have to follow. On an insurance panel, you’ll likely earn less per patient, but can make up the difference by higher volume.
Which Insurance Panels Should I Join?
There is no single ‘best’ insurance panel to join. The right insurance panel for you depends upon your individual situation and the region in which you work.
However, the largest insurance panels are often a good place to start for most providers. These large insurance companies have clients all across the United States. As a provider, you always want to maximize the number of potential patients that you can treat. Being admitted to a large insurance panel can significantly impact the success of your practice.
Some of the largest insurance companies in the country whose panels you should consider joining are:
- Blue Cross Blue Shield
- Aetna
- Cigna
- Humana
- Value Options
- TRICARE
- Medicare
- UnitedHealthcare
- Anthem
- Centene
- Emblem Health
- Kaiser Foundation
Due Diligence
Keep in mind that there is no one size fits all approach to joining an insurance panel. You should always do your due diligence when you consider partnering with an insurance company. Picking an insurance panel to join simply because it’s one of the largest in the nation is not a good enough reason.
Instead, research your community and the predominant needs of its population.
For example, if you work in a state like North Carolina, you should know that active duty military personnel and veterans constitute a high percentage of the population. Therefore, TRICARE would be a good option for you. Blue Cross Blue Shield is one of the most popular insurance companies on the market, but if you live in Connecticut, you should know that Emblem Health is actually the most popular health insurance company in your state.1
The Value of Smaller Insurance Panels
Of course, joining the panel of an insurance company that serves many people in your region is a good idea. However, you can miss out on significant revenue by neglecting to join smaller insurance panels, too.
Let’s say that Company A insures 150 people in your area, while Company B serves 65, Company C serves 55, and Company D serves 40. At first glance, you may think that Company A is clearly superior, and you should focus on working with that panel. However, Companies B, C, and D have a combined patient network of 160—more than Company A.
Therefore, if the credentialing process for Company A is very long and difficult, or if the reimbursement rates for Company A aren’t that great, it may actually be a better decision to join the other panels.
Avoid Insurance Panel Headaches with Healthcents
Often, providers want to join an insurance panel but are outright denied by the insurance company. Even those who aren’t flat out denied by the insurance company often have to wait an extremely long time to join a panel, and have to agree to poor reimbursement rates.
With Healthcents, you have someone fighting for you when the insurance company says no, or when they propose poor rates and other contract language that hurts your practice.
Healthcents is the number one healthcare credentialing contract management solution. In all 50 states, you can work with Healthcents and have a team of strategists negotiate on your behalf with insurance companies.
Healthcents helps providers sign better contracts, manage their professional relationships, earn more revenue, expand their practice, and more. To get help with insurance panels or any other aspect of the contracting process, contact Healthcents today.
Sources:
- ValuePenguin. Largest Health Insurance Companies of 2021. https://www.valuepenguin.com/largest-health-insurance-companies
- Medical Credentialing. Which Insurance Panels Are Best for Me? https://medicalcredentialing.org/which-insurance-panels-are-best-for-me/
- TheraNest. What are Insurance Panels? https://theranest.com/blog/insurance-panels-what-they-are-and-how-to-get-on-one/
- Advantum Health. Healthcare Credentialing Documents Checklist. https://advantumhealth.com/healthcare-credentialing-documents-checklist/
