What is a closed panel?
To see a patient who wants to use their "in-network" benefits, you will need to be an “in-network provider”. This means that you have been credentialed and contracted with the patient's insurance company. When an insurance company feels that they have reached an adequate number of providers for a specialty in the area, they will close that panel and no longer issue contracts for new providers/groups. This can be extremely frustrating for a new business owner.
How to overcome the closed panel?
Many insurance companies will tell you to call back in 6-12 months to see if the panel has re-opened. But many insurance companies will accept some sort of appeal letter, allowing the practitioner to state their case for why an exception should be made. These appeal letters are not guaranteed to be accepted but there are a few key factors that could increase your chances.
- Hours of operation- Go on Google and check the hours of operation for clinics in your area that have the same specialty as your practice. Maybe you will see that there are no clinics open later than 6:00 PM, this is where you could prove your worth to the insurance companies. By adjusting your hours to meet the needs of your service location, insurance companies may make an exception because it benefits their members.
- Keep a list- If you have patients coming into your clinic but you cannot accept their insurance because of a closed panel, document it! Write down the patient’s name and member ID, then once you have a list of 50-100 patients, submit your appeal letter along with your list. Showing the insurance company that their members are seeking you out can be a persuasive tool in getting into the closed panel.
- Specialty- The amazing thing about physical therapy is that there are a lot of different specialties that can be included in a practice. Whether it's orthopedics, sports medicine, or pediatrics. These specialties could be your golden ticket into a closed panel. If your practice offers specialty services or has specialty equipment that your competitors don't, make sure to include that in your appeal letter.
As stated previously, none of these are guaranteed to sway the insurance company into making an exception for your business but including the factors that set your business apart certainly doesn’t hurt. If you have any credentialing questions, please feel free to reach out to the experts at Account Matters at 508-422-0233.