Each day, I have the pleasure of consulting with therapists nationwide who want to build their practices by joining insurance plans.  But I get almost as many emails from providers who want support in considering the pros and cons of resigning from some (or all) of the plans in which they participate, and the steps involved.  If you’ve never left an insurance plan, you might be surprised that getting off a network isn’t as easy as you might think.  Here are some steps involved in this exit, and some tips:

1. Think twice. It may be hard to rejoin if you change your mind, so don’t make this decision out of anger.
2. Consider asking for a raise, if reimbursement rates are the main issue.  Check my article on this topic — click here
3. Plan ahead. Your contract may require 2- 4 months’ notice before leaving. Check your contract, or contact the plan.
4. Contact Provider Relations to find out where to send your resignation letter, and how much notice you need to give. You can’t resign via Post-It note on a claim, or fire off an email to any office at the plan.
5. Usually you must resign in writing.  Many plans accept a fax.
6. Name a proposed resignation date that gives the required notice, but know that the plan might alter it depending on when they input your request in their computers.
7. Ask the plan to hold new referrals until the resignation is official.
8. Get written confirmation from the plan. Follow up within 30 days of your letter to be sure they received it.  Then once you are off they panel, contact them again to be sure you are off their provider list.  Otherwise, future claims from clients with out of network benefits may be incorrectly processed.
9. Give clients several months’ notice.  Discuss it with each client, then give them a follow up email or letter with your resignation date, how this will affect them, and what their options are for continuing treatment, including referral to a plan provider.  Keep a copy of this in the client’s chart, and document all discussions in your notes.  Don’t wait — the plan may send clients a letter notifying them of your resignation, and you don’t want clients to find out that way.
10. Have clients check if they have out-of-network benefits that might cover therapy after you leave the network.
11. Decide if you will offer affected clients a reduced fee, or perhaps just for a period of time.
12. Consider how it may affect each client emotionally. This may bring to the surface abandonment issues, shame about finances, whether the client values therapy enough to pay out of pocket, or serve as an uncomfortable reminder to both of you that this is a business relationship. (It may also bring to the surface YOUR issues around money and therapy, as you discuss fees with these clients)
13. Have continuing clients sign a “Self-Pay Agreement.” This agreement states that as of a certain date their sessions with you will no longer be covered by their plan, states the fee they must pay, and that you will no longer be billing insurance for them. (I have a sample Self Pay Agreement in my Practice Forms Packet and in my book).
14. Remember: Resigning does not mean you are free of chart reviews or treatment reviews by health plans.  Your clients with out-of-network benefits will be submitting invoices to their insurance plans, so your notes must always document medical necessity for treatment.  For more on great documentation, check out my webinar “What Should be in Your Charts; Writing Great Notes” — click here

_________________________________________________

Barbara Griswold, LMFT is a private practice coach and the author of Navigating the Insurance Maze:The Therapist’s Complete Guide to to Working With Insurance — And Whether You Should, 10th edition.  Check out Barbara’s online catalog of helpful online courses, practice forms, and other therapist resources related to insurance, documentation, and running your therapy business here.