Four ways to find out if an insurance panel is closed in your area. Part 2 of 4

This article in the series(Article 2 of 4), we will provide you with 4 ways to identify any panel closures in the area.r Our hope is that you’re discovering this information prior to signing a lease.  Having opened thousands of practices, we understand better than anyone how challenging opening a new practice is.  It’s an unfortunate truth that the insurance companies have made this process all the more difficult.  Just this week, we worked with a new practice in Florida that was refused by all major insurance companies.  This was in part due to a lack of board certification but I’m honestly not sure how much would have changed if he would have already passed the boards.  The reason behind the panel closures(according to the payers), was due to a lack of network need, which translated, means that they have an over saturation of providers in the same specialty within 20 miles of the proposed location.  Home based, mobile, telemedicine and pain management clinics are encountering the highest rate of panel closures in 2019.  

4 ways to find out if insurance panels are closed

 

  1. You can talk to a credentialing company(such as ours ; ).  Panel closures are often on a case-by-case basis and the payer’s attitude/network objectives frequently change.  With that being said, we nor any other credentialing company will be able to give you a definitive answer regarding panel closures.  However, we will let you know if we have encountered panel closures in the area you’re considering.  This information will at least allow you to plan for the worst case scenario as you move through the start-up process. 
  2. Before contacting us, it’s always best to confer with your colleagues, preferably in the same county, to see if they’ve encountered any roadblocks with payers.  Community physicians often have their ears to the ground and can let you know if they’ve heard of any horror stories.
  3. We’ve also found success in having new practices speak to the managed care team at their local hospital to see if they’ve experienced any contracting issues with payers.  Hospitals are frequently offering guarantees to new practices so any payer panel closures would be illuminated during the start-up process.  As long as the new practice isn’t employed, but functioning under their own tax-id, the contracting with that new practice would go through the same process you will regardless of who is providing the financial backing,.
  4. Finally, if none of these options work for you, find a few practices that opened in your area(preferably the same specialty if available) and put on your patient hat.  You can review their website first to see what plans are listed but this can be misleading due to all of the plan types so it’s best to pick up the phone.  You can also email if that’s an option on their website.  Here’s how you approach this question: Hello, my name is John Smith and I am in the process of selecting a new insurance plan through my employer and am hoping you can help.  I did some research and I would like to eventually schedule an appointment once my  insurance is in place.  Can you tell me if there are any of the major plans that you do not participate with at this time and if you anticipate this changing in the coming months?  Yes, this is deceptive so if you prefer the honest approach then just email them that you plan to be their competition and are wondering what insurance plans they accept.  The bottomline is, you want to find out what the new practices in your area have had trouble getting contracted with.

We hope that you found this information helpful as you navigate your way through the start-up process.  Please don’t hesitate to contact us should you have any questions about the start-up process or panel closures.

 



Leave a Reply

Your email address will not be published. Required fields are marked *