How to Break Ties With an Insurance Company

We talk a lot about opting out of insurance, but exactly HOW do you opt-out? If you've decided you are finished participating with a low-paying health insurance company, it's important to follow certain steps to ensure a smooth transition. You will need to inform both your patients and the insurance company of your decision. Here's a step-by-step guide:

1. Review Your Contract: Carefully review your contract with the health insurance company to understand the terms and conditions for opting out. Pay close attention to any clauses related to termination or opting out of the agreement. If you have used a credentialling company they may be able to help you through the process. If you have not looked at your contract in a while, call the insurance provider relations department. You may need to go to the insurance's website to download and submit a termination form. When I was opting out this was the hardest part of the process - finding the information.
2. Notify the Insurance Company: Write a formal letter on letterhead or email to the insurance company stating your intention to opt out of participating in their network. Include the effective date of termination, which is typically 30 to 90 days from the date of the notification, depending on your contract terms. You may need to fill out a formal termination form as well as send a letter. One insurance I contracted with needed 180 days' notice of termination. Print a copy of the letter for yourself and send the letter by certified mail.
3. Inform Your Patients: Tell your patients about your decision to opt out of the insurance network. Consider sending out letters or emails and posting notices in your office. The best way is to discuss the changes during appointments. It can be a hard conversation but patients appreciate the face-to-face dialogue. Provide ample notice to your patients, 3 months or more is ideal. This will allow them time to make arrangements if they wish to continue seeing you.
4. Provide Alternatives for Payment: Offer alternative payment options for patients who are currently covered by the insurance company you're opting out of. This could include accepting cash payments, credit cards, HSA or FSA. If they have a PPO you may be able to provide them with a superbill to submit to their insurance for reimbursement.
5. Provide a List of Alternative Doctors: For patients who choose to continue to use their insurance benefits provide them with a list of doctors who participate with their insurance.
6. Inform Your Staff: Ensure that your staff is trained to handle inquiries from patients regarding insurance coverage and payment options, like Care Credit, HSA, and FSA. Train them on how to provide patients with a superbill with ICD 10 and procedure codes to submit to their insurance.
7. Handle Existing Appointments: Honor any existing appointments with patients who are covered by the insurance company you're opting out of. Make sure you are clear on the opt-out date. The insurance company will not pay you for patients seen after the opt-out date. Inform your patients of the changes and discuss payment options for future visits.
8. Follow-Up with the Insurance Company: After submitting your notification to opt out, follow up with the provider relations at the insurance company to confirm receipt and the opt-out date. This will ensure that your termination is processed correctly. Verify on the insurance website that you are no longer a participating physician. It may take several months after your opt-out date to be removed from the insurance website.
9. Update Marketing Materials: Update your website, brochures, and any other marketing materials to reflect the changes in insurance participation. Clearly state which insurance plans you continue to accept and any changes to payment policies.
10. Monitor Transition Period: Expect some hiccups. Patients may forget that you opted out or may have switched insurance carriers. Your staff may forget to collect payment at the time of the visit. Keep track of any potential issues or challenges that arise during the transition period. Address any concerns from patients or staff promptly and professionally.

By following these steps, you can effectively opt out of participating with a health insurance company while minimizing disruptions to your practice and maintaining positive relationships with your patients.