Accepting Insurance at Your Private Practice: What You Need to Know

January 2nd, 2023 | Private Medical Practice

Many physicians with their own private practice have to decide whether to accept insurance or not. While the process is different depending on each practice and insurance company, a physician should consider a few key things.

Learn what you need to know about private practice accreditation and how a private practice consultant can help.

The Pros of Accepting Insurance

Choosing to accept insurance is an important decision for your private practice. As a physician, you may be on the fence about taking that step, but there are many pros of accepting insurance:

  • More referrals — Once you become credentialed by insurance companies, you can access automatic referrals through the providers’ network. You may also get referrals from other physicians who are part of that same network.
  • Guaranteed visits — Each insurance company covers a different number of patient visits, depending on the patient’s coverage plan. However, you are often guaranteed a set amount of visits each year that insurance companies provide.
  • Access for patients of various incomes — Without insurance, many patients cannot afford healthcare out-of-pocket. If you accept insurance at your private practice, you may have access to patients of various incomes and walks of life.

The Cons of Accepting Insurance

While accepting insurance has many pros, it doesn’t come without its troubles. Insurance can make a positive impact on your practice, but there are also some cons to consider:

  • The credentialing process — To accept insurance, physicians in private practice must go through a grueling credentialing process. This process can take several months, putting your ability to accept insurance on hold.
  • Pay delays — Once you see a patient, you must file a claim with the insurance company. The payout can take up to 30 days, and your claim might get rejected or delayed due to discrepancies. 
  • Rates set by the insurance company — While accepting insurance can lead to more patients and more income, the insurance company often dictates the rates you are paid. These rates can be non-negotiable even when they don’t make sense for your practice.

The Process of Credentialing

To get credentialed, you must fill out an application to join an insurance provider panel. After that, you will probably have to fill out an application with the Council for Affordable Quality Healthcare (CAQH) to become verified. This application can be used and sent to each insurance company. 

If that insurance company approves your application, you can become credentialed through that company and will be able to provide services to the patients in their network. Unfortunately, the credentialing process can take up to six months, making it necessary for physicians to have self-pay methods or out-of-network billing available until the insurance is approved.

How to Choose an Insurance Panel

The insurance panel you join often depends on the location of your practice. If your practice is in an area with several providers, that panel may be closed due to the number of providers they already have. 

While the location of your practice matters, your specialty can be the deciding factor for the insurance panels. Many insurance companies want unique services to offer their customers, which is where your practice would come in. To find the right insurance panel for your practice, there are several questions you should ask yourself:

  • How much could you make with the insurance company compared to how much you could make without accepting insurance?
  • How quickly can the insurance company reimburse you?
  • Have you or other providers experienced issues with the insurance company?

When you’re starting out on your own practice, making decisions about insurance providers can be challenging. Other physicians in your area may be able to point you in the right direction and give you their experiences with each company.

Learn About Accepting Insurance At Your Private Practice With Help From Rockett Healthcare Strategies

Insurance can be a tricky yet rewarding aspect of your private practice. While the pros and cons of insurance accreditation may vary depending on your practice, a private practice consultant can help with your decision.

At Rockett Healthcare Strategies, Rock can walk you through the insurance process and provide you with the right tools to get started.

Reach out to Rockett Healthcare Strategies today for help building your private practice!