How to Become an Eligible Provider for Insurance Benefits

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As you start a career in the medical or dental field, you will find that the majority of your patients have health insurance that pays for medical and dental treatments. Those individuals will make up the majority of your business, so you need to become a health care provider who accepts as many insurance payments as possible. While this is easier for doctors who maintain their own practice, it is still important for individuals, such as licensed massage therapists and other less popular medical specialists, to become an eligible provider who accepts insurance benefits.

Contact your state insurance commissioner's office first, especially in medical fields that many deem less necessary (such as massage therapy) to make sure you are, in fact, eligible to accept payments from insurance companies.

Ask about the requirements for becoming an eligible provider, such as liability insurance, experience, how long your practice is open, space requirements and handicap access. Be sure to meet all requirements before proceeding.

Request provider applications from the major insurance companies in the area. It's a good idea to start with the local hospitals because they typically provide insurance coverage to their employees and the community and are often the most widely used plans.

Fill out the application. It will likely request a lot of details. Take your time and be sure to respond to each question and request thoroughly. You will also need to show the insurance company how your practice can save money in the long run. For example, a couple of months of your physical therapy for a shoulder injury may mean that surgery isn't necessary.

Read the entire contract with the insurance company before signing anything. Be sure you are willing and able to comply with all regulations and restrictions set forth in the agreement. Consider hiring an attorney to look over the application for you and make sure you and your practice have protection.

Discover what current procedural terminology (CPT) codes you can use to categorize your patients' bills. The insurance company will likely require you to bill allowable rates when billing a patient's plan. For example, providers that work with a particular hospital plan may work out a deal that the provider will only charge so much for certain treatments, and the insurance company will list your practice as an in-network provider (bringing you more business).

Tips & Warnings

  • If a patient comes in with insurance coverage from a company you didn't contact, be sure to call that insurance company before providing service to the patient and find out if it will pay your practice anything at all through the plan. The insurance company may consider you an out-of-network provider, which usually means it doesn't pay as much of the bill, but will likely cover at least 50 percent.

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