When you apply to be a provider for an insurance company, sometimes they will say they are closed to new providers in your area. They will say they have too many providers to credential anyone else for the time being. But there are ways around a so-called closed insurance panel. Learn how to get around the rules and get on a closed insurance panel.
Insurance panels can sometimes make it difficult to get credentialed. Highmark has a reputation for making it easy for providers but many of the others aren’t so easy. Many providers think that when the insurance panel says it is closed, there is nothing you can do but that isn’t the case. Use the steps below if your application has been denied or you were informed that the panel is closed.
How to Get on Closed Insurance Panels
The first thing you have to do is find out who to contact. You want to find a phone number, address or e-mail address for credentialing. If you can, find out who the provider representative is for your area. The provider representative is the person who handles relations with providers. They are usually assigned by county.
The provider representative will be more familiar with the area you want credentialed in. So, you may get further talking to a provider representative than calling the national number for credentialing. It is always better to communicate with a person than call a national number or send a letter to the company. You never know if you will reach the right person by sending a “to whom it may concern” letter. And it may fall on deaf ears. But if you can reach the provider representative for your county, you may be able to convince them to help you.
Before you contact them, think about why you should be included in the network. Write a letter with information on your specialties and why they are needed in your area. If you have a certification or experience in an area that is in demand, you may be able to make a case for being included in the network. Certifications go a long way to show you have the education and experience for different specialties. If you have experience but not a certification, consider getting the certification.
In addition to specialties, think about what sets you apart from other providers. You may take Saturday or Sunday appointments which other providers don’t. Or you may have a more private office which can be a real plus for clients who don’t want people to know they are in therapy. We may have come a long way but there is still a stigma attached to mental health treatment. Some people don’t want to sit in a waiting room with other people.
Points to Consider
- Do you have any specialties that are needed?
- Do you have certifications?
- Have you had any trainings in special areas?
- Do you take weekend and evening appointments?
- Do you have an office with exceptional privacy?
- Do you offer special testing or techniques others don’t offer?
When you contact the company or provider representative (whether by phone or letter), explain your situation, why you want on their network and why you think they need you on their network. You want to let them know they need you as much as you want them. It’s just like going on an interview. You want to let the company know you are a good fit for their needs.
If you have a client who has the insurance and is paying cash, they can write a letter or call their insurance. They can request that you be included in the network and explain why they need you as a provider over someone else. If you get phone calls from people with the insurance that want to see you, let them know that you would like to have them as a client but you cannot take their insurance. Inform them that they can call and request that you be added as a provider. Most people don’t know they can request that a provider be added to their insurance.
Letter to Closed Insurance Panel
If you make a good case to be included, a closed insurance panel may add you to their network. Below, I included a sample letter for how to approach a closed insurance panel. Remember, it is usually better to talk to a person. However, I think it’s a good idea to write a letter first so you know what points to make.
Be sure to highlight your specialty and the need for it. Give details when possible such as how many phone calls you have gotten from people with the insurance you are trying to get credentialed with. Be honest but play up what you have to offer.
My application for credentialing with your network was recently denied. The denial letter stated there are too many providers in my area. However, there are some factors I would like you to consider that set my practice apart from other providers in my area.
I am a Certified Addiction Counselor and have 10 years experience working in this field. There is a great need for addiction providers in my area. There are 10 Suboxone doctors in my county and many of them have no providers to refer to. I get referrals from several doctors who need a referral source for Blank insurance. I get several calls a month from people requesting my services who have Blank insurance and would like to have me as their provider.
In addition to my specialty, my office is located so that it is extremely private for clients. The waiting room is situated so that a client leaving my office cannot see another client who is waiting. Due to the stigma attached to addiction, this is of great benefit to my clients.
I hope you will reconsider adding me to your network. I would like to discuss this in further detail with you. You can reach me at XXX-XXX-XXXX.
Your Name and Credentials