Now that I had admitting hospital privileges, I proceeded to apply for private insurance carriers (Howie’s note: I believe most carriers and IPAs will credential you while hospital privileges are pending) . Once again, my goal is to be on the majority of private insurance panels on opening day. It’s a lofty goal, but I think I’ve done all that I can to maximize this likelihood. As you can see, a lot of things need be in place before even being able to apply, so I do now believe that this whole process can really take over 6 months to complete.
Normally, you would contact each insurance company to request a network provider application package. In the past, you would have had to complete a separate grueling application for each company. These days however, most insurance companies use the CAQH (Council for Affordable Quality Healthcare) common application system, which saves time and headache for both the applicant and the reviewer. I went over the CAQH application in the last post.
You can also obtain insurance contracts by joining an independent practice association (IPA). I chose this route for most of my contracts. An IPA is a physician-assembled private organization that holds contracts with a number of insurance companies. The IPA directly credentials all applicants, and grants members access to these contracts. The nice thing about IPA’s is that they can have a faster credentialing process because they only deal with applicants within the county.
The one drawback of an IPA is that you would have to accept all contracted fee schedules. Having said that, some insurance companies don’t even allow you to negotiate fee schedules anyway. Also, this particular IPA’s fee schedules were comparable to those offered to independently credentialed providers. I can pick and choose which insurance companies I want to accept by the way. Unfortunately, this IPA does not have contracts with Blue Cross of California and Cigna. Thus, I will have to go through CAQH with these companies.
I actually had to apply to 2 IPA’s before being accepted into one. I wasn’t even given an application with the first one because they had “no need” for another ophthalmologist. As a side note, I’m not really sure if it’s even legal to deny membership because of “no need.” I’ve read that in most states, the “Any Willing Provider” law requires insurance companies to accept all providers who meet credentialing standards and are willing to accept the companies’ terms and conditions. Hence, this law prevents insurance companies from limiting network providers as a way to save costs. Having said that, it looks like there’s an ongoing lawsuit in California with Blue Cross because of this exact issue. You can read more about it at: http://www.physicians-vs-bluecross.com/ by the way. I’m not sure if the “Any Willing Provider” law applies to IPA’s, and didn’t really pursue it
Thankfully, the second IPA was fast and awesome. I was offered membership a little over a week after I sent in my application! Part of it was because of just lucky timing though. The application required the same things as my hospital privileges application. I had to submit copies of my California medical license, DEA certificate, CV, malpractice insurance, hospital privileges verification form, and my intentions for board certification. This time, the application fee was $200. A day after I mailed in my application, the credentialing coordinator was super kind enough to tell me that she would try to get my credentialing in order within the next few days, so that I could get in for an interview at their monthly committee meeting the week after. Once again, the interview was also mainly a formality. This time, however, I did say more than 2 words. Still, the entire interview was friendly and uneventful. The committee just wanted to put a face to the application.
Two days after the interview, I received an official acceptance letter to this IPA. Of course, nothing’s for free. My annual membership will cost $600, and I will need to make a one time stock purchase for $1,500. Fine by me. In addition, I had to sign a provider contract agreement, and to fill out a few supplemental forms and a W-9 for my corporation and myself. By contracting through this IPA, I won’t be subject to any special restrictions or requirements with the insurance companies. Also, the claims process will be directly through each insurance company. So, now I’m just waiting for my contracts to become fully executed, which will take 30 to 60 days. Once that goes through, I’ll be able to see patients on these insurance panels. At this point, I’m looking at a February or March open date, so this timeline works perfect for me.