How can you get your insurance provider to sign up doctors as in-network?

In-network doctors

I actually contract with Physicians for an insurance company and quite often I get requests to go recruit a particular doctor. First of all, there are Department of Health requirements which state there must be a participating doctor of each specialty within a certain mile radius of each zip code in each county in order to actually sell insurance into that county. I would check to see what that mile radius is in your county, because if you have to travel that far, perhaps you can get an exception to see a non participating provider at the in-network benefit level since the access requirements aren't being met.

In order to get your doctor to participate, I would contact your member services area. Have the customer service representative forward your doctor's information to PROVIDER RELATIONS. Provider relations will then contact your provider to see if he would like to become participating. Usually there is an application that needs to be submitted by the doctor. Then, each doc must be credentialed..that is their information must be verified and approved by a board of medical professionals who are employed by the Insurance Company. Once approved, the doctor can be added.

One tip, however. Many doctors get approached to participate in various plans on a regular basic. This is not normally a high priority for a physician, especially if they are not aware that they have patients who may have that insurance. If you want your doctor to participate, call him or her and advised them of what insurance you would like them to join. Explain why and ask them if you can do anything to help the process along. Sometimes the biggest motivator for the physician is a vocal patient!

First answer by anonymous. Last edit by Critmark. Contributor trust: 281 [recommend contributor]. Question popularity: 264 [recommend question]