The Benefits of Participating With Insurance Carriers
 

Why do I Need to Participate With Insurance Carriers?

Many times, new providers do not fully understand all of the benefits of participating with the different insurance carriers. The decision to participate or not to participate, has a bigger effect than you might imagine on the overall earnings potential, as well as the number of clients that a provider can expect to have in the long run.

If you are reading this as a billing service, it is very important to advise your clients of the advantages, as well as the disadvantages of participating with each of the insurance companies in your region.
 

How Will Participating Benefit Me?     You will be listed in the directory that is given to every patient by the insurance carrier, which is great advertising for your practice.   You will know both exactly what the insurance carrier will pay you, as well as how long it will take you to collect your money   Most patients only look for and use providers who participate with their particular insurance carrier   Payments are made directly to you by the insurance carrier

 
Obviously, the benefits may vary according to medical specialties.

Generally speaking, before a patient even decides to make an appointment with a particular provider, they first call to see if their insurance carrier is on the list that the office accepts. This way, they already know exactly what they will have to pay out of pocket, and can be financially prepared for the copay that will be required. The provider then bills the insurance carrier for the service, and will receive the “allowable” designated amount for the particular service from the insurance company.

The provider must abide by the rules of that insurance carrier regarding how and when that claim is filed and how the patient is medically treated.

Referrals, authorizations, or treatment plans may be required, and sometimes it seems as if the insurance carrier makes the provider jump through hoops to get paid.

 

Points for You to Consider  The insurance carrier determines your fees  You must wait for the payment  You must abide by the insurance company’s rules  The Insurance carrier may require extra paperwork  You may have to obtain or complete referral forms  You may have to submit treatment notes or plans You must fit in the insurance company’s guidelines  You must complete the credentialing application

For most providers, it is beneficial to participate with most insurance plans, this process is called medical credentialing. There are a few companies that are just more headaches for the provider than it is worth.

In order to make an informed decision, you will need to consider your specialty, your patient base, and each individual carrier’s requirements and reimbursement rate.
 

Many times, new providers do not fully understand all of the benefits of participating with the different insurance carriers. The decision to participate or not to participate, has a bigger effect than you might imagine on the overall earnings potential, as well as the number of clients that a provider can expect to have in the long run.

If you are reading this as a billing service, it is very important to advise your clients of the advantages, as well as the disadvantages of participating with each of the insurance companies in your region.
 

Information About Medical Credentialing   CAQH Credentialing Medicare Credentialing Medical Credentialing

 

* You must remember, that the agreement you make with an insurance carrier is a legally binding contract, and if you do not abide by the rules that you agree upon, you may lose money on unpaid claims and at the worst it may be construed as insurance fraud.