Nine Important Details to Look for in Your Insurance Contract

Treating patients that have autism spectrum disorder (ASD) through the miracle that is applied behavior analysis is a truly meaningful service. But in order for families and patients to get the help that they need, they are going to need the proper insurance coverage.
At Amvik Solutions, we take pride in providing crucial backbone services like medical billing, payroll, and practice management software to ABA therapy practices. Throughout the years in servicing startup practices, we have garnered enough knowledge on what to look for when devising a contract with an insurance company.
Now, we look to pass that knowledge on to you. Consider these nine important details when you are negotiating your next contract with an insurance company.

1. Look for a Timely Filing Deadline

Billing for ABA therapy can be difficult at times. Complications can mount up, and before you know it, you’ve missed out on your timely filing deadline. Contracts that have as little as a 60-day deadline can be considered too short of a time for your practice to bill the insurance company.
Be sure that you find what the deadline is during your initial read-through of the contract, and don’t be afraid to ask for more time if you think your practice may need it.

2. Check the Deadline for Appeals

Listed within a contract, you’ll find the amount of time allotted to file an appeal or dispute if a claim hasn’t been paid correctly. As ABA therapy grows and becomes defined across the nation, the claims side of this treatment still has a few wrinkles to iron out. Oftentimes, claims are denied or processed incorrectly because of just how new ABA therapy is.
Of course, in a busy practice that is getting into its own groove, this deadline, too, can come and go unexpectedly. There is no shame in asking for an extension to this deadline in your contract. In fact, depending on your state, the law may even be on your side to assist you in this area.

3. Take Note of the Material Change Process

An insurance company has only so long to inform you of any material changes made to their operations or procedures, but when your practice is contracted with several insurance companies, keeping up with all of them can be a challenge.
This is why it’s so important to check notification standards and restrictions if a material change is made to your contract. If an insurance company is going to make a substantial change to your contract, such as adjustments to fee schedule or other types of serious modifications that can alter your clinic’s financial well-being, you’re going to need a timely notification about it.
Some contracts may have a period of 15 to 20 days, which is hardly any time to receive notice and become acquainted with material changes to your contract, where others may have a 90 day period – which is ideal.
Lastly, make sure that you are aware of what type of notification process will be used. This can include: written letter, website update, newsletter, or any other form of communication.
If you feel that you weren’t properly notified within a timely manner, there is the possibility that you will be able to dispute the changes.

4. Take Note of the Disputing Material Change Process

Understand how much time will be allotted for you to reply and dispute any material changes to your contract. Make sure to also note the particular method and steps you must submit take to submit your dispute. The insurance company will have to negotiate with you before issuing any changes to your contract.
This doesn’t apply to government insurances like Medicaid or TRICARE.

5. Research to Ensure the Insurance Company Has HMO Networks in Your Area

It is also important to note that some managed care organizations will offer quite a few HMO policies, and providers may be out-of-network unless HMO networks are included within the contract.
Do your homework on what’s available in your area. As patients get word of the ABA services you offer, track whether or not they have a specific HMO policy with their insurance. Don’t be afraid to contact the insurer and ask if they can include any local HMO policies into your contract.

6. Understand the Terms of the Contract

Within your contract, you should be able to spot with relative ease where your term period is and how frequent the contract will renew moving forward. It is common for the initial term period to last anywhere between one to three years.
During that time frame, the contract is binding, so you cannot send a request to terminate the contract until after the initial term period has concluded. For your own benefit, however, it may be a good idea to negotiate the term period if it exceeds two years. This is important just in case any material changes are made to the contract that put you in a bad financial spot.

7. Check if Electronic Billing is an Option

If you are looking to make your practice more efficient, electronic billing will do just that. It is a fastest, most efficient way to process claims, especially if your practice is still in its growing phase.
Not only does electronic billing speed up the claims process, it expedites payments and gives you the benefit of keeping track of everything online in your own system and through the plan’s online portal. By default, the ease of record-keeping that electronic billing provides will also help if you need to dispute a claim.

8. Check the Contract for any Credentialing and Clinical Requirements

If you see that your insurance plan has any credentialing and clinical requirements in the contract, make sure you ask a representative if there are any stipulations that you must meet immediately. These rules can be a deal breaker.
Make sure to have a list of questions prepared when you discuss these stipulations. This will save you from entering a binding contract with a company that requires unreasonable conditions that must be met – especially if yours is a startup practice.

9. Read Your State Addendum

Many national insurances will come with their own standard language that they send to every provider, along with a state addendum that will specify any additional terms according to your state’s own regulations. Read it carefully to check if any sections within the addendum have replaced language within the contract. Important administrative differences may be included, depending on your state.
Should you practice ABA therapy in multiple states, you should be equipped with multiple copies of the addendum per state.

We don’t just support ABA practices with medical billing services, payroll services, or practice management software, we also offer valuable insight to make the founding of your ABA therapy practice less challenging.

Negotiating contracts with insurance companies can be overwhelming to anyone trying to start their own practice, but don’t lose hope. Ultimately, establishing relationships with multiple insurers will help you treat a lot of patients that need your expertise.
Contact Amvik Solutions to learn more about our services.