Physical Therapy Practice: 3 tips to becoming credentialed with insurance companies

When you first make that leap of faith into the private practice PT arena, you start to realize that there is A LOT you don’t know anything about.  Even if you’re the best physical therapist on earth, you won’t survive if you don’t get paid.  For those of us private practice physical therapists that do elect to accept health insurance, it’s certainly not an easy process to become a provider for each of them.

After some reflection about my past with trying to become providers for Aetna, United Healthcare, Humana, and so on, I thought it would be beneficial to new start ups to provide some tips on making this easier.

1. Choose a location for your practice that has a high volume of potential patients, but a low amount of competition among physical therapists.

This seems obvious to most people going into any type of business, but that is not always the case.  New practice owners may choose to open in their own town because it’s easy for them and they aren’t afraid of a little competition among the community, not realizing that this may limit them during the credentialing process.  The more providers like you in a certain location, the quicker the network becomes closed off.

2. Document EVERYTHING!

Start a spreadsheet from day one documenting who you contacted, how you contacted them, and what the outcome was.  If the “network is closed” this spreadsheet becomes extremely important when trying to gain leverage later on down to the road.  Call and email the credentialing department weekly; most likely you will not speak to the same person.  A lot of times you will get many different answers, and by keeping track of who said what, you can leverage getting into their system by tracking everything and using this information to your benefit.  This worked extremely well for us when trying to get into Blue Cross Blue Shield.

3. The most important — create a niche practice

Creating a niche physical therapy practice doesn’t necessarily mean you need additional letters behind your name, or a special certification of some kind.  The beauty of our profession is that you can actually be an “expert” in neurology, orthopedics, lymphedema, pediatrics, or anything for that matter, without having to actually take some type of certification exam.  Insurance companies do not look for certifications to prove or disprove this is your specialty.

I started my practice with a love for outpatient neurology, that was my background – TBI, CVA, SCI, and so on.  I created a niche in the community that was under served.  And although I don’t have a title saying that I am a neuro certified specialist, certainly does not mean I don’t know what I am doing.  Experience counts for a lot.

I’d love to hear other comments from physical therapists about tricks or tips they have used to help gain access to otherwise closed insurance networks!


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