-Build a name and connection for yourself (Board Certified, specialized, maintain connection and relationship with insurance).
-Ask about how you can become an in-network provider that receives referrals from insurance.
-Pre-authorization on all insurance, talk to the insurance company of your new patients prior to billing for all sessions (telehealth or in-person). If you aren’t willing to from the onset ask patients to pay for a first consultation session and don’t offer a free consultation session, get the insurance information upon first contact with new patients. Know which services are covered, co-pays, and higher level of care coverage.
-When you call insurance for a patient have this information ready:
2) Date of Birth
3) Address of Patient
4) Contact Phone Number
5) Insurance Policy ID/Group #
6) Understand patient’s history and symptoms requiring level of care
7) ICD 10 Code
8) Treatment Plan
9 )Know an exact number of days/sessions/services you’re asking for coverage for before you call. (Remember: you’re the one who must advocate for your patient and the services they deserve).
10) Note: authorization numbers, person who authorized, their phone number/ID number, dates of coverage, review date, and contact policy if patient discontinues services or treatment.
*Some insurance companies require paperwork in addition to phone pre-authorization, some just require paperwork, ask the insurance company which they prefer. Be timely with this information, follow up, and track dates you contact insurance.
-BE Clear, Concise, and Assertive with insurance representative. Indicate that you are trying to understand the patient's benefits structure for the types of services you provide (for example: mental health, medical, inpatient, outpatient, or intensive outpatient).
-If you are finding that you are repeating yourself several times or being connected more than 3 times to different people, ask for an upper level representative or that you would like to speak to a supervisor. Many users have told us they have luck getting codes after talking to an upper level representative.
-Ask the person you are speaking to for their name and ID number, and contact phone number/extension. Ensure you do this each time you are connected again.
-Once you get that supervisor or upper level supervisor you have a paper trail of what they put you through. Track the time you’re on the phone.
Have more questions? Contact firstname.lastname@example.org