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). Know which services are covered, co-pays, and higher level of care coverage.
When you call insurance for a patient have this information ready:
- Date of Birth
- Address of Patient
- Contact Phone Number
- Insurance Policy ID/Group #
- Understand patient’s history and symptoms requiring level of care
- ICD 10 Code
- Treatment Plan
- 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).
- 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