Service Overview
Termination of Insurance Network Participation
Empowering Providers in Assessing their Relationship with Insurance
Many dental practices are assessing their relationship with insurance companies and participation in their networks.
It can be an overwhelming experience to consider becoming a non-participating provider. At Carrell Law in Hugo, MN, we understand the intricacies of these situations and are committed to providing support to help you navigate this decision. Our process starts with providing guidance on how your practice can analyze your current participation and the potential opportunities for exiting your insurance relationships. We review your insurance contracts to determine the legal requirements to terminate your relationship with support throughout the entire process.
Understanding your reasons behind insurance network terminations is crucial for addressing them effectively. The most common cause is related to low reimbursement amount. At Carrell Law, we specialize in advocating for providers like you, ensuring your insurance network participation is strategic, and your practice can thrive even in the face of rising operational costs
Do You Need to Hire an Attorney for This?
Absolutely not! Most practices assess this strategy, determine next steps, and execute the termination without an attorney or outside vendor. This page will outline the steps to do this all on your own. However, Carrell Law clients reach out with similar questions about how to terminate the relationship and what to do when the contractual terms are not met. Use this page as a guide and reach out if we can help you in the process.
Common Reasons for Network Termination
While every insurance network operates under its own policies, there are some common reasons for termination, which may include:
- Low Allowed Amounts: Network participation means accepting lower fees from insurance companies – how low are your fees?
- Broad Participation: Insurance network participation should be strategic – know where there is overlap in your participation and if a better strategy would benefit your practice.
- Policy Violations: The delay of payment on clean claims or inaccurate denials have practices evaluating network participation.
At Carrell Law, we help providers address these challenges with clarity and assertiveness, ensuring every detail is considered.
Step-by-Step Guide: Define Your Practice’s Strategic Participation Plan
A successful practice is intentional about their business and decisions made. Assessing your network participation is an important strategic business decision that should be analyzed on a recurring basis. This is especially true as market conditions change. By using the steps below, you can assess insurance participation and be intentional about your relationship as a provider. This includes steps to explore options for terminating your provider network status either on an individual network relationship or entirely. Our approach below walks you through the steps to think strategically about your business and empower you to make a data-driven decision.
Here’s your steps:
- Assessing your Participation: understand your practice's participation, practice data and network fees. This starts with an inventory of your network status by contract, including a list of payors accessed through each contract, with a compare of your office fees to the negotiated fees for each contract.
- Identifying you Patient Statistics: collect data specific to your practice including number of patients, production, and write offs per contract.
- Reviewing Insurance Contracts: identify all insurance contracts and understand the terms of your network agreements. This includes the termination provisions with notice requirements to insurance company and any requirements for notices to patients.
- Drafting Termination Notices: draft your termination notices with tracking tool for each network to ensure accurate processing. Send notices by trackable receipt – email, USPS tracking, and fax.
- Enforcing the Contract Terms: Some practices find themselves following up after termination notices are sent to advocate for compliance with the contractual terms of the Agreement. It is important to know the termination provisions along with provider manuals to know how to advocate for contract terms.
- Patient Communication Plan: This is a critical step in a strategic plan – identify how you will communicate to your patients including when and who.
Let us know how we can support you in this process.
How We Approach Termination of Insurance Network Participation
Insurance network terminations often follow a complex, lengthy process with practices experiencing challenges affecting the change. Our experience working with healthcare professionals in has shown that strategic participation in supporting your goals is key. With Carrell Law’s proactive strategies, you can stay one step ahead, minimizing impact to your practice.
- Assessing Your Situation: Every case begins with a thorough assessment to identify the specific reasons for termination and recommended next steps for your practice.
- Guided Communication: We help you communicate effectively with insurance networks, ensuring every point is clear, professional, and aligned with your best interests.
- Documentation and Compliance: Keeping detailed records and adhering to contractual requirements strengthens your process and can aid in contesting issues encountered throughout the process.
Whether your current network participation includes a handful or many networks, Carrell Law is ready to assist you in assessing your strategic choice of participation
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