To be an insurance provider or not to be an insurance provider...that is the question, and it's a topic that we—speech-language pathologists in private practice—have discussed and will continue to discuss endlessly. No one answer fits all. Each provider has to make his or her own decision. Looking at the advantages and disadvantages may help you decide.
One big advantage to becoming a provider for insurance companies is the exposure—you have a constant referral source that requires little work or expense from you. With insurance companies, you are free to provide services to clients on the days and hours that you choose—unlike, for example, school contracts that limit the days and hours that you can see clients. The payer's reimbursement rate, however, may be a big concern—each insurance company sets its own "reasonable and customary" fees.
Some things to keep in mind:
- Some insurance companies have set rates, although you may be able to negotiate your own rate with a particular company.
- If you choose to be a provider for a health insurance company, read all of the company's provider literature. Some companies limit the number of visits per beneficiary, either per year or per lifetime. An adult who has traumatic brain injury or stroke, for example, and who had 90 sessions of treatment for speech-language delays as a preschooler, may not be eligible for reimbursed services today.
- Make sure your client understands that an insurance policy is a contract between the client and the insurance company. As the client's provider, I will help ensure coverage, but there is nothing that I can do about exclusions in the client's contract. Some companies, for example, exclude services related to developmental delays or articulation, and requests for coverage and appeals of denials won't result in coverage. Even various policies within the same insurance company are different.
To avoid surprises, my practice uses a system to determine all the insurance information up front:
- When a prospective client (or client parent) calls for an appointment, we complete a client questionnaire with basic information, including insurance information.
- We tell callers to check with their insurance company if they have not already done so. Most companies provide information on their websites.
- We log into our secure accounts on the health insurance company's site and print out the material related to speech-language treatment, including the amount of the client's copayment. It's amazing how many people have never read their policies. Some have substantial deductibles (as high as $10,000); others have exclusions, such as articulation or stuttering treatment.
- We include this information in the intake packet we send to all new clients. We don't want surprises on the first visit.
When you question participating with insurance companies, you have to look at your own practice. SLPs often ask how I can participate with a particular insurance company that has a low reimbursement rate. In my practice, the clients with this insurance help keep my clinicians busy during slow periods, and they generally require very little paperwork. However, higher-paying insurers that require progress reports every six sessions (yes, some do!) may not be worth it because of the time needed for additional reports. Remember, also, that every client represents a potential referral source.
The big advantages for not accepting insurance are lower bookkeeping costs and (usually) higher payments. However, depending upon the economy, your local demographics and the number of other SLPs in your area, independence may not be the best choice. If, conversely, you are highly specialized or the only clinician for miles around, staying independent may work out well.
Look at all the facts before you delve into the world of insurance. Make sure it's the best fit for your practice.