What Does It Actually Look Like To Work With Insurance?

The Realities of Getting Your Own Insurance Contracts and Credentialing as a Mental Health Therapist

For many therapists looking to grow their private practice, getting credentialed with insurance companies is a critical step. While being in-network can provide a steady flow of clients and more accessibility to care, the process of obtaining insurance contracts and going through credentialing is often more complex than expected. Let’s break down what’s really involved.

Step 1: Determine Which Insurance Panels to Join

Before starting the credentialing process, it’s essential to decide which insurance companies you want to contract with. Some factors to consider:

• Client Demographics: Which insurance providers are most commonly used by your ideal clients? The most largest insurance entities nationally are Aetna, Optum/United, BCBS/Anthem, Cigna, and Medicare/Medicaid. There are likely smaller, local insurance companies that may cover your local unions or a work with a specific demographic that you're interested in (e.g. first responders). Start by asking your clients or ideal clients what insurance they currently have.
• Reimbursement Rates: Some insurance companies pay significantly more than others. Ask and google to find comparisons for your local rates.
• Administrative Burden: Some insurers have more complex billing and authorization requirements than others. BCBS is famously complicated but can reimburse very well and covers many people who you may want to work with.

Step 2: Gather Required Documentation

To apply for credentialing, you’ll need to compile a range of documents. Commonly required materials include:

• Professional license
• Malpractice insurance certificate
• NPI (National Provider Identifier) number
• CAQH (Council for Affordable Quality Healthcare) profile
• W-9 tax form
• Resume or CV
• Proof of graduate education and supervised clinical hours

Having these documents organized and up to date will help streamline the process.

Step 3: Apply for Credentialing

Once you’ve selected your target insurance companies, you’ll submit your application for credentialing. This can typically be done via:

• The insurance company's online provider portal
• A paper application (less common, but some insurers still use this)
• CAQH ProView, which many insurers use for credentialing verification

Step 4: Wait (and Follow Up)

The credentialing process can take anywhere from 60 to 180 days—or even longer in some cases. It’s crucial to:

• Regularly follow up with the insurance company to check on the status of your application. We recommend following up at least once every week while you're waiting.
• Respond promptly to any requests for additional information or clarifications.
• Keep track of each insurer’s timeline and contact details for easy follow-up.

Step 5: Contract Negotiation and Approval

Once credentialed, you will receive a contract outlining reimbursement rates, billing policies, and other terms. Some key points to review include:

• Fee schedules: Make sure the reimbursement rates align with your financial goals.
• Claims submission process: Understand how and when to file claims to avoid payment delays.
• Authorization requirements: Some plans require pre-authorizations for certain services.

If the rates seem too low, you may be able to negotiate—though success varies by insurer.

Step 6: Getting Set Up to Bill Insurance

After signing your contract, you’ll need to:

• Get enrolled in the insurance company’s provider billing system.
• Set up an EHR (Electronic Health Record) system with billing capabilities.
• Learn the specific coding and documentation requirements to ensure claims get paid.
• You may also want to enroll for electronic payments so you can quickly get paid directly to your bank account rather than waiting for paper checks in the mail.

Common Challenges in the Process

• Panel Closures: Some insurers claim their provider networks are “full” and are not accepting new applications.
• Delays and Lost Paperwork: Credentialing departments are often slow and may misplace documents.
• Reimbursement Disputes: You may find that some insurance companies initially underpay or reject claims, requiring appeals.

Alternatives to Full Credentialing

If credentialing seems too time-consuming, consider:

• Private Pay Model: Avoid insurance altogether and work directly with clients.
• Superbills: Provide clients with invoices they can submit to their insurance for partial reimbursement.
• Joining a Group Practice: Some group practices handle credentialing and billing for you.
• Working Under Group Contracts: Companies like Alma and Headway get you set up under their contracts which can be quicker than doing your own credentialing. 

Final Thoughts

Getting credentialed with insurance companies as a mental health therapist requires patience, persistence, and organization. There are also many companies and service providers that can help you through this process. While the process can be frustrating, being in-network can expand your client base and make your services more accessible. By understanding the steps and preparing for potential roadblocks, you can navigate credentialing more effectively and set yourself up for long-term success in your practice.