SLP circles debate on the matter of accepting insurance. This is especially so in locations with complex forms of insurance systems, like the U.S.
In some cases, SLPs decide to use private pay instead to avoid the hassle. But many starting SLPs still have the same questions: How do SLPs get paid? Do they have to provide insurance or are they mostly private pay? Can I do both for my practice?
Based on our survey along with some research, here are some of the key information to help with your decision.
To cap things off, we will let you in on our experience and thoughts from doing digital advertising for many private practices with a mix of private pay and those that accept insurance. We’ll also let you in on a type of service that will help with insurance billing in the future, which may even include very low fees!
This article mainly applies to the complex system of accepting insurance in the US and billing practice could be different in other countries.
Insurance vs. Private Pay
You have two payment options for your services: via Insurance (where you will be a provider) or Private Pay (where your client will pay you directly).
Being part of an insurance network means that you have an agreement with an insurance company to provide care for its members. This is usually done in exchange for a discounted rate, or a specific payment scheme agreed upon. Clients that have an insurance plan will need to present their enrollment or membership to use their insurance for your services.
Accepting payments as private pay simply means that you ask for payment directly from the client. Private Pay is generally more expensive for clients since the fees will come from their pockets without insurance. However if they have insurance plans with other networks you are not a provider for, then you are considered as out-of-network, where they can reimburse the fees they paid themselves.
Do SLPs Accept Insurance: Our Survey Results
61% of our US respondents accept insurance, with 9% saying they only accept insurance, while 52% said that they do both insurance and private pay.
SLPs also find insurance valuable to their business. 44% said that not accepting insurance is a bad idea. Yet there is a 15% of our respondent group that said they have never needed it and they only bill private pay.
Pros of Accepting Insurance: Competitive Advantage and Larger Network
1) Expand your Client Base
According to our private pay-only clients, the number one reason for rejection is the fact that they do not accept insurance. Insurance can grow the potential of your client base and to an extension your revenue.
Being a provider will place you on your insurance partner’s therapist list. Clients with insurance plans tend to shop around these lists more. It’s likely to be less expensive for the client and may prioritize an in-network provider more than an out-of-network therapist, whether they be better or not.
2) Stay Competitive
You will gain a competitive edge if you sign on to accept insurance. This is especially so when there are a lot of SLPs and clinics in your area.
Having a lot of providers in an area can lead to clients sticking to who they know, or what is most accessible to them. To potential clients with insurance plans, that would mean therapists connected to their network.
3) Makes your business easier to scale
If you are thinking about scaling your business, it would be helpful to accept insurance. With the extra channel that helps clients find you, it will help you serve more and grow your business more effectively.
4) Helps with Marketing
When you choose to do solely private pay, you will have to start marketing your services on your own. You need to market to every pediatrician, family doctor and other possible client bases in your area. This of course is possible, but it can be very time-consuming and you will cover only a small scale of your community.
Accepting insurance will put you on the insurance company’s list for those that have speech therapy coverage.
However, we’ve found that there are effective ways to market your SLP practice other than agreeing to accept insurance. You can learn more about our marketing survey results to see how other speech therapists find their clients.
Cons of Accepting Insurance: Lower Fees and Complicated Processing
1) Discounted Fees
This is the primary pay-off concern for SLPs when they consider accepting insurance.
Some insurance companies have arrangements for reimbursement per service or contracting discounted rates for their members. In many cases, private pay rates will be higher than insurance reimbursement rates, resulting in less revenue for the SLP.
2) Complicated Application and Set-Up
Accepting insurance involves a more complicated process than simply accepting private pay direct from clients. There is paperwork to be filled out to apply, and you as a provider will be evaluated from your qualifications to be approved.
These qualifications can include registration and licenses to practise speech therapy. Sometimes it also includes certification and training on the speech therapy services you provide. Some insurance companies need their providers to have healthcare provider liability insurance, and other insurances involved with your practice.
3) Pre-Treatment Verification and Added Paperwork
When you become a provider, you need to verify the speech therapy coverage of your patients. This is just another step in the process you must deal with before you provide treatment.
The paper trail also will not end there when you have been an accepted provider. Billing will also include a lot of paperwork on your end and payments are subject to the approval or denial of your insurance partner.
It’s clear from many Facebook group posts and comments that dealing with insurance companies’ claim denials are a huge headache. However, there is an option that many therapists opt to do: outsource the insurance billing to 3rd party companies.
These companies can submit and chase claims on your behalf, and some will even help confirm your client’s therapy coverage and credentials prior to starting treatment. We’ve seen fees quoted from 4% up to 11% of the claim amounts they process but for some private practices, offloading this headache is worth the hefty fees. We’ll talk about one such billing company more below.
4) Restricted Treatment Plans
Due to the restrictions of the health insurance plans, patients may be restricted only to a few sessions or even a limited time per session. Sometimes reimbursements are untimed, meaning you get paid regardless of if the therapy is 15 minutes long or 60 minutes long. This means that you have to take these into consideration when it comes to planning and executing your client’s treatment plan and sessions.
Accepting Both Insurance and Private Pay:
Out of the options we gave in our survey, 52% of our US SLP respondents say that they do both insurance and private pay. Instead of seeing insurance as the ultimate choice, it can simply be an added payment channel that allows you to work with more clients.
Abeona’s Experience with both Private Pay and Insurance-Accepting Clients
As we’ve mentioned before, the number one reason a client rejects private pay-exclusive SLPs is due to the fact that they don’t accept insurance. They spent a lot of effort on potential client leads who just say “no” and move on to speech therapists that accept insurance. This reflects on the Client Acquisition Costs (or CAC) of these SLPs, which are typically 50%-75% higher than average.
However, this doesn’t mean that you are locked to accepting insurance. Our advice is always to give the client a good reason (or reasons) to pay for your speech therapy services out of their own pocket. Clearly define your unique selling proposition(s) so they don’t need to look elsewhere!
Insurance Paperwork Pro-Tip: Medical Billing Companies
Earlier we discussed the hassle of billing in the SLP business, especially when accepting insurance. To help with this, a few of our clients told us about the option of using a medical billing company. They generally provide affordable outsourced billing services including recording patient benefits, posting payments, submitting and following up on claims.
One of their key propositions is a more affordable alternative to the typical 8% to 12% range for fees. Given the fact that credit card processing fees are generally around 3% for private pay, the availability of a decent reimbursement rate along with hiring an affordable billing company might make sense towards starting to accept insurance.
We’re keeping a lookout and asking SLP’s about the best available medical billing companies out there to bridge the gap of insurance, so stay tuned for our findings.
With the proper unique selling proposition, we’ve also had success finding clients through Google Ads that are sure to help SLPs, whether they private pay or accepting insurance. If you have any questions or you’re looking forward to the same success, sign up for a free consultation below and see how we may help you grow your business.