Posted on August 18, 2020
Here's a complete guide to becoming an out of network provider: what it means to be out of network, how out of network therapy & billing works, and the steps to getting off insurance panels.
Therapy is more than a financial commitment; it’s a financial investment for patients. As a therapist, you’re not only trying to help people become aware of self-sabotaging patterns and more capable of practicing new, more effective thoughts and behaviors; you’re also running a business and you need to know how to grow your private practice or clientele. In an ideal world, you could both help anyone and be successful. But, human compassion and professional responsibility can often be at odds with making a comfortable living. It is important to make sure both you and your clients are a good match which can be made easier by a therapy matching service. It’s a delicate balance that you have to weigh when deciding how to set up your private practice. One of the critical decisions you can make in this regard is whether to accept health insurance coverage or become an out of network provider.
If out of network is the path you’ve chosen, let’s explore how to become an out of network provider with us at Advekit and how to be a successful therapist.
From medical care to the health insurance company, it is hard to navigate what is best as a healthcare professional. While you may lose out on some potential clients who cannot afford to go out of network, it isn’t a career death sentence. People want to have a choice in the providers they visit, and are usually willing to work with someone out-of-network if they feel they’re getting the services they want with a therapist who is a good fit. Many clients with great plans still seem to feel that working with the provider of their choice is worth the investment. Therapy is at least as valuable as other things that people pay for – massage, acupuncture, naturopathic doctors, vitamins, seeing a specialist.
Clients want extra help and they are willing to pay for services that go beyond the once-a-week therapy visit. On the flip side, the freedom allows you to practice the quality of clinical work you believe in, and offer extra services that you know will help the process for your patients. Unsurprisingly, clients seem happy to look to a therapist to help with a real treatment plan, rather than their insurance company. Clients also tend to act differently when they are paying for your services, rather than their insurance company. When a client is intentionally investing financially in the process, they more consistently invested emotionally and energetically as well. This can also be an effective marketing strategy for therapists who want to make genuine connections and one of the best referral courses for therapists.
If you’ve decided the benefits outweigh the challenges in becoming an out of network provider, you’ll need to resign from your insurance panels. The thought of letting go of the comfort of being on insurance panels can create a lot of anxiety for private practice therapists. After all, if you don’t have clients, you don’t get paid. But, did you know that you only need about half the number of clients in a self-pay practice to make the same income (or more) than you made in an insurance based practice? Exactly.
So, how do you resign in a thoughtful way that works for your current client base?
First, evaluate all the panels you are on and make a spreadsheet the following:
This list will help you determine the value of the panel and the order in which you should let them go. You might want to remove yourself from the most difficult panel first or the lowest reimbursing panel. Or, you might want to terminate with the easiest contract terms just so you can ease into the transition gradually.
It’s important to implement a process before you drop your first panel to make sure there is clear communication. Evaluate the order in which you will terminate and then draft a letter to notify clients, allowing time for process and termination, and potentially a referral. Be sure your information is updated in your marketing messaging as well.
If you happen to get a referral during your termination period with an insurance company, you have a couple of options. You can choose to refer the person out to another in network provider, or you can accept them and let them know the period in which insurance will cover and the plan for payment post termination with the insurance company. This way the client is fully aware of what they are agreeing to, and can make an informed decision. This might not be a process of saying goodbye to you clients; many may surprise you by wanting to still work with you, especially if you are able to offer existing clients a reduced rate out of network.
Advekit works with therapists who are both on insurance panels, and those who are not. If you’ve chosen to become an out of network provider, you’re solely responsible for administrative billing, so it’s imperative to have a professional system for billing and receipts. Advekit can help.
Our software solution allows clients to upload their insurance details and educates them on their out of network coverage in real-time. Clients get matched with you and see your cash rate, understanding that you are an "Out of Network" provider. Clients then enter insurance details, and instantly receive coverage breakdown. It makes it easy for healthcare professionals to provide their patient with an understanding of their insurance plan with the dreaded surprise billing as well as getting the care without worrying about understanding balance billing.
Clients only pay what they owe, and do not need to pay in full and wait for reimbursement. Advekit collects the client's payment and insurance details, and waits for you to indicate that the client has attended a session. Once a client has seen you for a session, Advekit charges the client's credit card, and pays you (therapist) immediately. Advekit then waits for reimbursement from insurance.
We handle all payment and process claims on behalf of the client, and pay our therapists immediately.
This process allows you to retain new and existing clients because they are happy to save money upfront through our system. 75% of therapists secure a client within the first 2 months, and 50% see an increase in reach outs from other sites. The biggest benefit for both you and client is that clients come to therapy more often. They feel better, and you get paid. It is the ultimate provider network.
Are you ready to become an out of network provider with Advekit? Learn more.
Alison LaSov, LMFT
Alison LaSov is a Licensed Marriage & Family Therapist with experience treating clients struggling with anxiety and depression. She predominantly focuses on mental health intervention for children and adolescents, particularly those who are in crisis. She has worked within the Los Angeles education system treating students with Individualized Education Plans (IEPs), as well as supervised a non-profit Teen Crisis Hotline out of Cedars-Sinai Hospital. Alison earned her B.A. from UCLA and M.A. from Pepperdine University. She is a native to Los Angeles and co-founder at Advekit.