The Impact of Being an In-Network ABA Therapy Provider

Amvik Solutions understands the vast range of decisions that go into the starting and running of your own ABA therapy practice.
Many of these choices concern the approach you take to treatment, based both on your training and experience, as well as those of your staff members.
There are also a number of administrative tasks that go into keeping your practice running and which also affect the cost that providing services.
One that is particularly important for your practice on a number of levels is deciding whether or not to contract with an insurance carrier and become a part of their network of providers.
Opting to become either “in-network” or an “out-of-network” provider will determine a great deal about your professional future.

Being An In-Network ABA Provider

There is something to be said for entering into a contract with a carrier. A major benefit is that there are more opportunities to grow the number of patients you treat.
As a member of a carrier’s network, the insurer will regularly refer prospective patients and their families to you. You will not have to spend as much time and effort, and financial resources, to get the word out about your practice.
Additionally, your carrier will likely list you on their website’s directory. Potential customers will have a much easier time finding your practice this way.
You will also have access to a number of services and information sources that might not be available to you if you operate outside of a network.
Another benefit to consider is that there will be no hassle submitting forms and claims electronically, which could be an issue if you are not a member. Many carriers also make coming by necessary information for running your practice easier to attain.
Best of all, you will be able to provide savings to families on the total cost of ABA therapy. You completely avoid the possibility of a patient not being covered by their insurance by operating in-network.
The major drawbacks to this kind of arrangement are having to follow the insurance carrier’s standards on certain things.
The way you practice can be restricted by a carrier’s guidelines. This is important to consider, especially when deciding whether you want complete autonomy in establishing treatment standards.
Additionally, the insurance company will often have set rates for different therapy services. As a part of their network, you will have to comply with the amounts they set for ABA treatment.

Working Outside of a Network

The main advantages of running your practice without a contract with an insurance carrier centers around increased freedom in deciding certain administrative decisions. You don’t have to follow the set rates and practice guidelines that come with an agreement with the insurance company.
You might also be able to negotiate the rates with them and adjust them to the benefit of your clinic and patients.
Many of the cons of being on your own deal with not having the reach of an insurer’s network. You lose the “marketing” done for your ABA practice on behalf of the network, so you will have to find other ways for your ABA therapy practice to get noticed.
Submitting claims may also become more problematic, as carriers will not have the same obligation to work with you as they would with in-network members.
Costs could ultimately be higher for your patients’ families as well. While you don’t have to charge copayments for treatment, those savings can be quickly lost in deductibles and other charges.
Families might also decide to seek therapy elsewhere if they do not have “out-of-network” provisions in their insurance policies. Without these provisions, there is the added financial burden of paying for ABA therapy services without help from their insurer.
The cost will be more unpredictable for your patients outside of an insurer’s network. That can affect your ability to attract and retain certain patients.

By helping your ABA agency get credentialed, Amvik Solutions will increase your reach and ability to provide the best quality mental health care to those who need it most.

The choice of entering into a contract with an insurance company and joining their network of providers can help your practice get the exposure it needs to grow and sustain clientele.
If you need help getting started with the credentialing process contact us today at 805-277-3392.
Whether your needs concern payroll, medical billing, or credentialing, Amvik Solutions has the expertise to take care of your operations, allowing you and your staff to focus on providing the best possible ABA therapy services.