Why I Chose To Go In Network with Insurance

When it comes to social pressures I’m not big on following the crowd. I like to make decisions guided by what I want and what feels right, not based on what other people think I should do or “experts” suggest. Not that I don’t use expert guidance, because I value much of it, but ultimately I make an effort to choose the right path for myself and not be too swayed by it if it doesn’t feel right.

For instance, you won’t see me wearing high heels because some fashion “expert” decides that women need them to look attractive or professional. They hurt! I skipped one of my classes in OT school because it was redundant (anatomy, we had it 3 times a week!). Apparently that created some shock amongst my classmates, but I did better studying on my own and had more preferred ways to spend my time.  How I run my business is no exception. The “crowd” is often switching from an insurance-based practice to a cash-based one. Well, I had a cash practice for years before deciding to go in-network with insurance. With all of the hassles that come with insurance, why would I do that?

Going In Network Helped Me Help More People

When I first opened my pediatric private practice I couldn’t imagine trying to figure out how to run a business AND how to learn the ins and outs of insurance. It was just too much. Once I was up and running and felt like I knew what I was doing it started to bother me that people who lacked funds weren’t able to get quality services as easily. Since it was relatively easy to get credentialed and the pay was decent enough, I decided to take Medicaid.

After another year or so I realized how many clients I was turning away because I was out of network and decided to try to go in network with a private insurance company. It wasn’t just about the potential income; this alone was not reason enough for me. I wanted people with insurance to have the opportunity for quality care. Not that there weren’t good therapists around, but I read evaluation reports and heard stories from places that were therapy “factories,” where they overburdened therapists, had limited consultation with parents, and where the children weren’t getting the practical and functional skills they needed to meet their goals. I wanted to make sure they had other options.

 Learning About Insurance Takes Time

There is a lot to learn with insurance. I received my first insurance check 4 months after the date of service, but it came quickly after switching to a new biller. That was pretty exciting! 

I was very intimidated by insurance when I started, but it became less daunting because I had people who could answer questions. One of the realities of being in network with private insurance is that you don’t always get a clear answer when there is a glitch with billing or checking benefits, even when you call. You may also have to deal with some trial and error, like which diagnosis codes are acceptable to that insurer, what modifiers you need, and what and when to charge your clients if they have a large deductible. It’s less intimidating when you just accept that it isn’t simple or cut and dry. 

Get Some Support

One of the things I had to learn the hard way was that just because someone calls themselves a biller does not mean that they have a clue what they are doing. I had 3 billers, all who were recommended to me by another therapist, and all were AWFUL. I learned a little from them, but ultimately lost a lot of money because of their incompetence; however, along the way I learned what I needed to do so I didn’t have to rely on a biller.  I ended up hiring someone and training her, and despite having no medical knowledge or background she has been amazing. 

Be Flexible

Whatever model you choose to have for your practice, be prepared to be flexible and open-minded so you can make decisions based on what you truly want and what feels right, and be prepared to realize that what you want may change. Also remember that it doesn’t have to be all or nothing. You can choose to go in network with only one or two insurance companies, you don’t need to do them all.