PRACTICE BASICS: 5 steps for resigning from managed care panels
Given the state of the economy, we’ve been surprised by the number of clinicians who continue to express an interest in removing themselves from one or more managed care panels. Some are simply aggravated--as providers frequently are --by managed care hassles. But more commonly, they plan to continue seeing managed care patients--but on an out-of-network basis.
Regardless of the reason, therapists sometimes find that getting off a panel is harder than they’d anticipated. To gain some insight into why that is--and to gather ideas for getting the job done right--we spoke to a pair of billing professionals, each of whom works with therapist-clients from across the country. They offer the following tips:
1. Plan ahead, and don't expect instant obedience. “If you want to be off certain panels starting in 2011, you should really start the process in September,” says Tara Thomas, who runs T&T Medical Billing in New York. The amount of lead time required will vary. “I think Magellan is the longest among the major companies at 90 days, so if you start in September, you’ll be clear by the end of the year...But then Aetna requires just 30 days notice.”
2. Find out who you have to notify. “Providers think they can fire off a letter to any office in the company,” says Jean Thoensen, who operates PsychBiller in suburban Washington, DC. “Sometimes they’ll put a handwritten note in with their claims but that does absolutely nothing.”
How do you find the right office to contact? “It’s not the complicated,” Tara Thomas says. “Call up provider relations, or credentialing, or with CIGNA the ‘network specialist.’ Ask them who you have to get in touch with to resign from the panel. Call that office, find out what the procedure is--and then follow it.” In some cases, she adds, you’ll need to specify which panel you’re resigning from--PPO, EAP, etc.
Incidentally, a fax is often all that’s required. In the past, we were told that a letter--sent by certified mail with a return receipt--is the best way to resign. But Thomas and Thoensen say that usually won’t be necessary. “I usually fax those letters,” Thoensen says. “There aren’t that many companies that say you have to mail them.” Thomas adds: “With UBH, you can just go online to take care of it.”
3. Get ready to repeat the procedure...and repeat it again. “Resigning from a panel isn’t the typical transaction for company employees,” Jean Thoensen says. “It gets messed up all the time. So once you’ve followed the procedure--whatever it is--go back a month later and make sure it’s actually been taken care of. You may have to do two or more follow-ups to make sure that it happened and you’re really off the books.
“You should also let the clinical side know,” Thoensen goes on. That’s not in your contract--and it shouldn’t be your responsibility--but very often different parts of the company don’t communicate too well. So provider relations may have you off the panel, but the office where they do authorizations doesn’t.”
4. But before you actually resign, consider the implications. Is it a good long-term strategy to remove yourself from every panel? Tara Thomas recalls: “I had a provider who got off the ValueOptions panel. It was a fairly simple process, and she was happy she did it.
“So then she considered getting off UBH, too. But UBH was merging with a lot of other companies, and you never know whose behavioral health benefits are managed by them. A patient may walk in with different coverage, but it turns out UBH is the actual provider of behavioral health services. So we decided to stay on the UBH panel...It may be easier to get off the panel than to get back on,” Thomas adds.
5. Stay calm, and forget your conspiracy theories. Some clinicians have told us they think this or that company keeps losing their paperwork so they’ll have to keep taking the in-network rate. “I don’t think so,” Thoensen says. “They just don’t have the brightest bulbs working there.” Thomas concurs: “You have a lot of incompetent people working at insurance companies.”
Contacts: 1) Jean Thoensen, PsychBiller, LLC, Centreville, VA, (703) 266-8612, www.psychbiller.com; 2) Tara Thomas, T&T Medical Billing, Chester, NY, (888) 364-3858, www.ttmedbill.com. (Please note: both Thoensen and Thomas have helped their billing clients resign from managed care panels--but neither offers this as an a-la-carte service.)
Jean Thoensen tells us that one of the most common mistakes clinicians make in dealing with managed care companies is failing to keep them up-to-date on your mailing address, or addresses.
“The problem is that you might have many different departments within a single company maintaining an address for you: claims, provider relations, and possibly a separate department for tax-related forms.
“So even if you update one department, the others may not get the word. And it gets even more complicated if you’re using multiple addresses—one for your office, another for payments, and so on.
“I learned this the hard way. One client, a Virginia psychologist, worked one day a week at a group practice as an independent contractor. The other four days, he worked in his own private practice, which consisted of going into nursing homes and doing therapy there.
“United Healthcare took the 1099s for the entire group practice, put his name on the envelope, and mailed them all to the wrong address—somewhere up the street from their actual location.
“Meanwhile, his own 1099s vanished entirely.”
Where did his forms go? It’s not clear, but Thoensen is pretty sure they were all sent to one of the several nursing homes where the psychologist saw his own clients.
“They do things like that all the time. And most likely, the receptionist who was working at the nursing home the day his 1099s came in didn’t recognize my client’s name’because they were never there on the same day.
“So they were just thrown out, or returned to United as ‘addressee unknown.’
To make sure your vital tax documents don’t go astray after an office move, Thoensen recommends calling provider relations and asking them flat out: “I want to update my address for the 1099.”
“See where that takes you. They should know how to do that.” And as always, several weeks after the change is supposed to have been made, you should check back with the appropriate department to make sure.
Medicare trouble: Usually, misrouted mail is just an inconvenience. But Thoensen tells us that when you’re dealing with Medicare, it can cost you money.
“A CMS contractor sent a letter to another client of mine, but it was addressed to a facility where he hadn’t seen patients in over a year. Instead of forwarding it to him, the facility just sent it back to CMS...The trouble is, anytime a piece of mail gets sent back to CMS, that triggers revalidation. Basically, we had to re-enroll my client, and provide all the documentation as if he was brand new.”